Republican senators Joni Ernst, David Perdue and Thom Tillis are among nearly a dozen senators targeted by a multi-million dollar “dark money” ad campaign. (Photo by Chip Somodevilla/Getty Images)

A secretive “dark money” group, which claims to represent doctors and patients, engaged in a TV advertising blitz totaling at least $2.3 million from late July through mid-August. Its ads urge vulnerable senators to reject a proposal meant to cut down on expensive surprise medical bills.

Doctor Patient Unity, an obscure group that doesn’t list its members or disclose its funding, was incorporated in Virginia on July 23. Just a few days later, it ran its first TV ads during CNN’s broadcast of the Democratic presidential debate, a preview of the multi-million dollar ad blitz that would soon follow.

The TV ads, which aired in nearly a dozen states, key in on one of America’s top healthcare issues: unexpected medical bills. The answer, the group says, is not a government-imposed limit on the amount of money health care providers can charge to some out-of-network patients — a proposal that appears primed to pass the Senate.

“Rate setting would only serve insurance companies who are already making record profits, and hurt those who really matter … patients … us,” the ad says, before urging viewers to call their state’s U.S. senator who happens to be up for reelection in 2020.

The expensive ad push comes as lawmakers on both sides of the aisle refine legislation to clamp down on unexpected medical bills, where out-of-network patients are hit with exorbitant costs because the physician or hospital does not have a contract with the patient’s insurer. These unexpected bills, which can be hefty enough to bankrupt some Americans, often result from emergency room visits or ambulance rides.

Capitol Hill’s recent interest in the issue has sparked a lobbying and public relations war between providers and insurers. Hospital and physician trade groups are opposed to the same kind of “rate setting” mentioned in the ad as a giveaway to insurers, while insurers are eager to accuse providers of charging too much for emergency room visits.

Doctor Patient Unity targeted at least 11 senators, all of whom face tough reelection battles in 2020, with ads in their respective home states, according to OpenSecrets ad data and FCC records. Because such contracts are filed sporadically throughout the year by broadcasters, the data represents only filings submitted to the FCC through the present date and could change as new documents are processed.

The list includes highly endangered senators in toss-up races such as Cory Gardner (R-Colo.), Doug Jones (D-Ala.) and Martha McSally (R-Ariz.). Several of the senators mentioned are actively involved in legislation meant to address surprise medical bills.

“This is kind of putting these senators, all of whom are at least somewhat vulnerable in a reelection campaign, on notice that this group is willing to run attack ads against them — potentially willing to spend millions of dollars to defeat them — if they don’t vote in the correct way on this legislation,” said Travis Ridout, professor at Washington State University and co-director of the Wesleyan Media Project, which tracks political ads.

Members of Congress had hoped to address surprise medical bills before the August recess but were unable to finish the job.

Senators are looking at the Lower Health Care Costs Act, sponsored by Senate Health Committee leaders Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), as the bipartisan solution to the problem. The legislation would set the rates at which insurers would reimburse providers for out-of-network emergency care, a proposal widely opposed by hospital and physician groups.

The bill, which sailed through the committee that Sens. Tina Smith (D-Minn.), Susan Collins (R-Maine) and Jones currently sit on, is a top priority for Senate Majority Leader Mitch McConnell (R-Ky.).

Doctor Patient Unity did not respond to a request for comment regarding its funding. But the group uses similar language to some of the biggest healthcare organizations opposed to the “rate setting” introduced by a bipartisan group of senators.

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Its ads appear similar to those run by Physicians for Fair Coverage, a nonprofit that represents specialty physician companies. Specialty doctor groups, such as the well-funded American Society of Anesthesiologists and American College of Emergency Physicians, strongly oppose the “rate setting approach,” which they say would fundamentally disrupt health care delivery.

Powerful industry groups such as the American Hospital Association and the Association of American Medical Colleges oppose the bill, while the influential American Medical Association has also urged lawmakers to go a different route.

“Arbitrary, government-dictated reimbursement would result in significant unintended consequences for patients and create a disincentive for insurers to maintain adequate provider networks, particularly in rural America,” AMA said in a statement.

Doctor Patient Unity is effectively a counterbalance to the Coalition Against Surprise Medical Billing, a group publicly supported by some of the biggest insurance companies and groups, including Blue Cross Blue Shield Association and America’s Health Insurance Plans.

Sen. Bill Cassidy (R-La.), who is pushing a more provider-friendly bill along with co-sponsors David Perdue (R-Ga.) and Joni Ernst (R-Iowa), has criticized the Alexander/Murray bill for being too friendly to the insurance industry.

In addition to a multi-million dollar TV ad campaign, Doctor Patient Unity has also spent tens of thousands on radio ads and Facebook ads. Their Facebook ads mention numerous House members from both parties in addition to senators, urging users to contact their congressperson to “side with patients, not insurance companies.”

In July, hospitals and doctors scored a number of wins during the markup of legislation before the House Energy and Commerce Committee, including the option for doctors to appeal to an independent arbiter, a provision despised by insurers and supported by Doctor Patient Unity and providers.

The Senate appears to be the real challenge for providers, potentially explaining Doctor Patient Unity’s focus on vulnerable Republican senators.

The group ran a few ads during the CNN debates in late July, during which healthcare was a hot topic. It followed that up with a major ad blitz from August 1-7, airing ads on the largest television shows, including the first NFL preseason game. It spent far more money on ads in states represented by Perdue and Sen. Thom Tillis (R-N.C.) than any others.

In most cases, Doctor Patient Unity does not disclose that it mentions senators in its FCC filings, only listing “healthcare” as its topic. The broadcast stations airing ads framed as issue advocacy often write in the senators’ names and the topic of the ad themselves. A few stations noted they could not find the group’s members on its website.

Pictured is a registration file provided to an Iowa TV station. Doctor Patient Unity lists its address as a PO Box in Alabama.

An FCC filing for one of the group’s ad buys in Texas notes that it mentions both Republican Sens. Ted Cruz and John Cornyn in its ad, but only Cornyn is up for reelection in 2020.

Doctor Patient Unity contracts with Del Cielo Media to purchase its ads. The Alexandria, Va., firm worked with nearly a dozen conservative groups during last year’s midterms, including a “dark money” group supporting Sen. Marsha Blackburn (R-Tenn.).

These so-called issue ads do not need to be disclosed to the Federal Election Commission as they only mention federal candidates but do not strictly advocate for or against their election. When election season draws near, these kinds of ads do need to be disclosed to the FEC as electioneering expenses.



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