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Five Years in the Making: Consumer Advocates’ Role in Passing Comprehensive Surprise Billing Legislation

Quote from consumer about surprise billing and summary of blog

Today, Governor Kemp signed the Surprise Billing Consumer Protection Act into law! Georgians for a Healthy Future and our partners at Georgia Watch strongly supported this bipartisan bill to protect consumers from surprise out-of-network medical bills.

These exorbitant bills often burden patients with high amounts of medical debt. In fact, over half of debt collection actions contain medical debts, leading to bankruptcy for many consumers. Take George C. of Lilburn, for instance, who had his right foot amputated at an in-network hospital. Even after obtaining assurances from his insurer that the provider was in network, he still found himself stuck with costly medical bills. “I found out they used out-of-network providers when they assured me they would [not]. They would not dismiss the bills and I had no alternative but to file for bankruptcy,” said George, after receiving surprise medical bills totaling $60,000.

With the signing of the Surprise Billing Consumer Protection Act, the state has taken an important step toward protecting consumers from the nightmare scenario George experienced. Georgia is the 16th state to have adopted comprehensive protections against surprise medical bills, covering an estimated 2.5 million Georgia residents when the law goes into effect in 2021.

As a bonus, the legislation also allows Georgia to establish an all payer claims database (APCD), which is a powerful tool used by 19 other states. Georgia’s APCD will inform the surprise billing payment resolution process, but will also be used to help policymakers, stakeholders, and advocates develop better understandings of health care costs, use of services, population health trends, and disparities.

Thank you to all who followed the surprise billing debate and helped bring it across the finish line by contacting your legislators at each stage of the process!

This win was a long time in the making, and a very committed group of state leaders worked tirelessly on surprise medical bill protections for many years. That includes the bill sponsors, Sen. Chuck Hufstetler and Rep. Lee Hawkins, Chairman Richard Smith,  and the Governor and Lieutenant Governor and their staffs. Georgia Watch and Georgians for a Healthy Future (GHF) were fortunate to play meaningful roles as well.

The beginning of the debate

The Georgia General Assembly’s consideration of surprise billing protections stretches back to 2015 when legislators began to look at the inter-related issues of network adequacy and surprise out-of-network medical billing (called surprise billing or balance billing). Following the 2015 legislative session, the Georgia Senate convened the Consumer and Provider Protection Act study committee to look at these issues and to which GHF’s then Executive Director was appointed.

Picture of a speaker at a podium

To buttress the work of the committee and highlight the importance of addressing both surprise billing and network adequacy for consumers, Georgia Watch and GHF held the Getting What You Pay For policy forum in February 2016. As a result of the study committee’s work, the policy forum, and powerful advocacy by Georgia Watch and GHF, the 2016 legislative session saw the successful passage of SB 302, which required health insurers to maintain accurate lists (called “provider directories”) of in-network medical providers.

While the state legislature did not have the appetite to take on surprise billing in all of its complexities in 2016, Georgia Watch and GHF knew this important consumer issue had the attention of policymakers.


We did not want to lose the momentum for surprise billing protections. Using the time between the 2016 legislative session and the start of the 2017 session, Georgia Watch and GHF worked closely with legislative leaders to inform their thinking on the issue and to craft legislation. Unfortunately, the legislative options put forward by state leaders in the 2017 session failed because of disagreements between insurers and providers about how to resolve payment disputes.

Dedicated leadership by legislators and continued partnership with consumer advocates could not overcome the entrenched disagreements between doctors and hospitals, and health insurance companies over the costs of care. This dynamic continued through the 2018 and 2019 legislative sessions, leaving consumers vulnerable to expensive, unfair medical bills through no fault of their own.

“If you want to go fast, go alone. If you want to go far, go together.”

Recognizing the on-going stalemate, Georgia Watch and GHF thought carefully about how to overcome this impasse. After studying surprise billing successes in other states, we agreed that success would require a united front from legislative leaders with a Georgia-specific solution.

Georgia Watch and GHF approached Sen. Hufstetler, Chairman Smith, and Rep. Hawkins about pursuing a “united front” strategy in the summer of 2019, and as a result of the trusting relationships we had built with them over many years, they agreed to participate and guide the process. Through GHF’s relationships at Georgetown University’s Center on Health Insurance Reform, we were able to bring in national experts on surprise billing who shared the latest information on state and federal proposals and discussed how other states tackled major issues, both of which helped bring a few fresh ideas to the table. Sen. Hufstetler and Reps. Smith and Hawkins—as eager as we were to break the stalemate—used that information and input from Georgian Watch and Georgians for a Healthy Future to develop a solution that works for Georgia but that was informed by efforts in other states.

This bi-cameral strategy attracted the support of Gov. Kemp and Lt. Gov. Duncan, both of whom had already expressed interest in passing surprise billing protections. When HB 888 and SB 359 were introduced in January, state leaders showed courage and commitment by sticking with the approach they had collectively developed, even over the objections of some stakeholders.

As the bill moved through the General Assembly, more state legislators, hospitals, and provider groups lent their support to the legislation. Moving this bill across the finish line involved negotiation among multiple parties, support from our partners in the patient and consumer advocacy community, storytelling from consumers who had experienced surprise bills, and a reliance on the trusted relationships that Georgia Watch and GHF had with state leaders.

Our efforts now move to the Georgia Department of Insurance (DOI) and the Office of Health Strategy & Coordination (OHSC). DOI will write the rules that guide the implementation of surprise billing protections which will take effect on January 1, 2021. The OHSC will develop funding for and lead the creation of Georgia’s all payer claims database.

It is rare for a state to go from no protections to comprehensive protections in one fell swoop, especially with the near unanimous support we saw in the Georgia General Assembly. Georgia Watch and GHF believe that this success demonstrates the incredible impact of long-term, sustained consumer advocacy at the Georgia Capitol and in other spaces where decisions are made. This kind of advocacy takes staff time, focus, expertise, and resources, all of which are provided by individual donors and philanthropic funders like you.

Our organizations work for you but we cannot do our work without you! Please support our consumer advocacy efforts with a donation today. Thank you!

Consider a donation to our partners at Georgia Watch too!


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