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Doctors in Arizona are crafting a state ballot measure that would modify the new federal surprise billing law and drastically tilt the scales in their favor during behind-the-scenes billing negotiations in the state — with consumers ultimately picking up the tab.

On its surface, the draft ballot initiative, obtained by STAT, extends new federal protections for surprise medical bills to patients with insurance plans that operate in Arizona. But it would also strip out a key part of the federal arbitration process. And while the initiative is tabled in Arizona for now, it could still serve as a blueprint for health care providers in other states who want to collect higher payments in out-of-network disputes with health insurance companies.

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“This is a way to say, at least for [Arizona], ‘We can carve out a system that’s more favorable to providers,’” said Jack Hoadley, a health policy professor and surprise billing expert at Georgetown University who reviewed the draft ballot measure at STAT’s request. “I would expect others to try this, especially if it is successful.”

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