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♪ SOLEDAD: I’M SOLEDAD O’BRN.IE WELCOME TO “MATTER OF FACT.” IMAGINE THIS, YOU HAVE A ROUTINE MEDICAL PROCEDURE -- LET’S SAY A COLONOSCOPY. YOU’RE INSURED AND YOUR DOORCT IISN NETWORK. BUT THEN YOU GET AN UNEXPECTED BILL. THAT IS EXACTLY WHAT HAPPENED TO A WOMAN WHO GOT A COVID TEST IN AN EMERGENCY ROOM AND ENDED UP WITH A $6000 BILL BECAUSE THE TEST WENT TO AN OUTSIDE LAB NOT COVERED BY HER INSURANCE. THE JOURNAL OF THE ARIMECAN MEDICAL ASSOCIATION FOUND THAT ONE IN FIVE PATIENTS WERE THI WITH AN OUT-OF-NETWORK CHARGE AFTER HAVING SURGERY. THESE BILLS CAN SET YOU BACK HUNDREDS OR THOUSANDS OF DOS.LLAR 50% OF AMERICANS ARE CARRYGIN SOME MEDICAL DEBT RIGHT NOW ICWHH OF COURSE CAN MAKE PAYING THOSE BILLS AND MANAGING TIRHE REGULAR EXPENSES SEEM ALMOST IMPOSSIBLE. LLWE, RELIEF ARRIVED ON JANUARY 1 IN THE FORM OF A NEW LAW. THE "NO SURPRISES ACT" BANS MANY OF THESE SURPRISE BILLS. KATIE KEITH IS A RESEARCHER AT THE NTCEER ON HEALTH INSURANCE REFORMS AT GEORGETOWN UNIVERSITY. KATIE KEITH, SO NICE TO VEHA YOU. THANK YOU FOR TALKING WITH ME. SO, WE KNOW THAT THE "NO SURPRISES ACT" WENT INTO EFFECT ON JANUARY 1ST. WALK US THROUGH THE BASIC FEATURES OF THIS LEGISLATION AND WHAT EXACTLY IT DOES. KATIE: WHAT THE "NO SURPRISES ACT" MEANS IS THAT THOSE WITH PRIVATE HEALTH INSURANCE SHOULDN’T FACE WHAT WE CALL SURPRISE OUT-OF-NETWORK BILLS ANYMORE. AND WHAT I MEAN WHEN I SAY SURPRISE OUT-OF-NETWORK BILLS, THIS IS REALLY FOR PATIENTS OWH DO EVERYTHING RIGHT. IF YOU SCHEDULE SOME KD OFIN SERVICE, YOU MAKE SURE THAT THE FOLKS ARE GOING TO SEE YOU ARE IN NETWO.RK I WOULD EXPECT THAT MY ANESTHESIOLOGIST WOULD BE IN NETWORK, I DIDN’T CHOOSEHAT T DOCT.OR YOU KNOW, MAYBE YOU’RE IN AN EMERGENCY, YOU CAN’T PICK THE HOSPITAL YOU’RE GOING TO OR THE PHYSICIAN YOU’RE GOING TO SEE. YOU’RE TAKEN SIMPLY TO THE NEAREST EMERGENCY ROOM AND THEN YOU HAVE A SURPRISE BILL THAT LANDS IN YOUR MAIL. AND THESE BILLS CAN RANGE ANYWHERE FROM HUNDREDS OF DOLLARS TO, YOU KNOW, FIVE FIGURES. SOLEDAD: SO, WE GAVE AN EXAMPLE IN YOUR INTRODUCTION ABOUT A WOMAN WHO GOT A COVID TEST, NTWE TO THE E.R., DIDN’T REALE IZTHAT IT WAS SENT TO A LAB OUT-OF-NETWORK, HAD ISTH MULTI-THOUSAND DOLLAR FEE. HOW COMMON IS THAT? KATIE: IN GENERAL, THERE'’ ESTIMATES THAT ONE IN FIVE SPITHOAL VISITS RESULTS INNE O OF THESE OUT-OF-NETWORK BILLS. SOLEDAD: SO, WILL THIS LEGISLATION THEN JUST END THAT, NO MORE SURPRISE BILLS? KATIE: THE ONLY EXCEPTION WHERE YOU MIGHT SEE ONE OF THESE BILLS IS IYOF U’RE TAKEN BY A GROUND AMBULANCE. IT TENDS TO BE A LITTLE BIT MORE COMPLICATED. SOME OF THEM ARE OWNED BY CITIES AND COUNTIES. THERE WERE SEVERAL REASONSHY W CONGRESS DIDN’T TAKE THAT ON, BUT WE ARE STARTING TO SEE SOME ACTION AT THE STATE LEVEL. SOLEDAD: SO,F IYOU LOOK AT HOW HEALTHCARE COSTS HAVE BEEN RISING NOW, I THINK IT’S LIKE 37 PSTATES. PEOPLE THERE ARE PAYING 10% OF THEIR MEDIAN INCOME, IS GOING TO HEALTH CARE COSTS, AND IT SEEMS TO ME TO BE BOTH CRAZYND A UNSUSTAINABLE. KATIE: I COULDN’T AGREE MO.RE I WOULD EMPHASIZE, I THINK THAT 10% FIGURE THAT YOU’RE GIVIN IG, THINK THAT’S FOR PREMIUMS AND DEDUCTIBLES. SO, FOR FOLKS WHO WERE RECEIVING THESE SURPRISE BILLS, THEY WERE PAYING EVEN MORE TN HATHAT FOR, AGAIN, COSTS THAT THEY DIDN’T EVEN ANTICIPATE. SOLEDA SD:O THEN WHAT’S THE BEST STRATEGY TO LOWER HEALTHCARE COS?ST KATIE: IN THE UNITED STATES, WE JUST PAY SO MUCH MORE FOR HEALTH CARE THAN MANY OTHER -- IT’S SORT OF "IT’S THE PRICES, STUPID." AND SO, YOU KNOW, WE’RE PAYING SO MUCH MORE, IT’S ABOUT % 20OF OUR GDP, WHICH MEANS A FIFTH OF OUR ECONOMY IS DRIVEN BY ALHETHCARE. I THINK, OVER TIME, IT’S GOING TO BE LOOKING AT THOSE PRICES THAT PEOPLE ARE ACTUALLY BEING CHARGED. IT’S GOING TO BE PROBABLY FOCUSED ON VALUE-BASED CE,AR MAKING SURE WE’RE ACTUALLY GETTING THOSE OUTCOMES FOR THE AMOUNT THAT WE’RE INVESTING. BUT IT’S GOING TO TAKE A LOT OF WORK. SOLEDAD: IS THERE ANYTHING THAT YOU SEE ON THE HORIZON WHEREOU Y COULD AT LEAST HAVE SOME CONSISTENCY IN CTSOS, RIGHT? THAT, THAT EVEINN NEIGHBORHOODS, COMMUNITIES CLOSE TO EACH OTHER, A PROCEDURE, THE COST OF A PROCEDURE CAN VARY WILDLY. KATIE: YEAH, ABSOLUTELY, OR ENEV IF IT’S NOT CONSISTENT COSTS, WE SHOULD KNOW WHAT IT IS UP FRONT, SO YOU CAN BE, YOU KNOW, AN INRMFOED DECISION MAKER AND THEN GO TO THE PLACE YOU WANT TO GO .TO AND SO, ONE INITIATIVE THAT IS SORT OF SLOWLY ROLLING OUT IS A NEW TRANSPARENCY INITIATIVE. SO, THIS IS A REQUIREMENT THAT HOSPITALS IN PARTICULAR AND INSURANCE COMPANIES HAVE TO SORT OF TELL AND SHOW THE PRICES THAT THEY CHARGE FOR DIFFERENT THINGS, INCLUDING THREI NEGOTIATED RATES. THE QUESTION, I THINK, IS WILL PEOPLE USE THAT INFORMATN?IO SOME TYPES OF HEALTHCARE IS SORT OF SHOPPABLE LIKE THAT, YOU CAN LOOK IUPT BEFORE YOU GO. NOT ALL HEALTH CARE IS. SO, WE’LL AT LEAST HAVE A LITTLE BIT MORE INSIGHT INTO EXACTLY WHAT THOSE PRICES ARE, SO IT’S LESS OF A BLACK BOX FOR EVERYBODY. SOLEDAD: KATIE KEITH FROM THE CENTER ON HEALTH INSURANCE REFORMS. THANK YOU SO M