AHA, AMA Urge Appeals Court to Invalidate NSA Dispute Resolution Process

IN THE UNITED STATES COURT OF APPEALS 
FOR THE FIFTH CIRCUIT 

Texas Medical Association; Tyler Regional Hospital, L.L.C.; Doctor
Adam Corley, Plaintiffs–Appellees, 
v. 
United States Department of Health and Human Services; Department of Labor; Department of the Treasury; Xavier Becerra, Secretary, U.S. Department of Health and Human Services; Julie A. Su, Acting Secretary, U.S. Department of Labor; Janet Yellen, Secretary, U.S. Department of Treasury, Defendants–Appellants.  _____________________________________ 

Lifenet, Incorporated; East Texas Air One, Plaintiffs–Appellees, 
v. 
United States Department of Health and Human Services; Xavier Becerra, Secretary, U.S. Department of Health and Human Services; United States Department of the Treasury; Janet Yellen, Secretary, U.S. Department of Treasury; United States Department of Labor; Julie A. Su, Acting Secretary, U.S. Department of Labor; United States Office of Personnel Management; Kiran Ahuja, Defendants–Appellants.

On Appeal from the United States District Court 
for the Eastern District of Texas, Tyler Division

BRIEF FOR AMICI CURIAE AMERICAN HOSPITAL ASSOCIATION AND AMERICAN MEDICAL ASSOCIATION IN SUPPORT OF PLAINTIFFS-APPELLEES 

Counsel for Amici Curiae American Hospital Association and
American Medical Association

INTRODUCTION
No one disputes that Congress’s principal intention in enacting the No Surprises Act (NSA) was to shield patients from unexpected medical bills. The AHA, the AMA, and their members strongly support this goal. But in “tak[ing] the consumer out of the middle” of billing disputes, Congress understood the need to establish a fair mechanism for healthcare providers and insurers to determine fair payment among themselves. H.R. Rep. No. 116-615, at 56-58 (2020) (quotation marks omitted). To “strike[] an appropriate balance,” Congress coupled a “benchmark rate model” with an independent dispute resolution (IDR) process. Id. Under this “baseball-style” process, id., arbitrators “shall consider” a list of statutorily enumerated factors in deciding between an insurer’s or provider’s offers, 42 U.S.C. § 300gg-111(c)(5)(C). The AMA and AHA supported this congressionally designed compromise, which both protected patients from surprise medical bills and established an intentionally balanced approach that did not skew towards either providers or insurers.

View the detailed brief below.