Earlier this fall, President Trump issued an executive order asking Congress to pass a solution for surprise medical billing before December 31, 2020. While Congress has since acted in good faith to bring forth legislative solutions that protect patients, hold insurers accountable, and preserve access to care, their latest proposal misses the mark.
For those fortunate enough not to have received one, a surprise medical bill is when a patient unknowingly receives care from a costlier out-of-network provider. For instance, this often happens during an unexpected ambulance ride to an out-of-network hospital or an urgent care visit where a specialty doctor is not recognized by one’s insurance provider.
The COVID-19 pandemic brought this problem even more into the national spotlight. There are mounting reports of Americans receiving charges for thousands of dollars after being tested for COVID-19, adding a new worry for those looking to stay safe amid the pandemic.
To solve this problem, Congress recently brought forth a compromise they believe will end surprise medical bills once and for all. The proposal, however, may do more harm than good.
The House Energy and Commerce Committee, working alongside the Senate Health, Education, Labor, and Pensions (HELP) Committee, developed a proposal using a one-sided method that favors the insurance industry over patients and medical providers. Included in the bill is a provision called rate-setting, which authorizes the government to work hand-in-hand with insurance companies to dictate medical rates however they see fit, something Americans overwhelmingly oppose. To make matters worse, the Congressional Budget Office estimates that rate-setting would result in a 20 percent pay cut for doctors and nurses – the same healthcare heroes who have been working tirelessly to provide patients with quality care during the COVID-19 pandemic.
The proposal is painted as a compromise because it incorporates a method called Independent Dispute Resolution (IDR), a proven method which requires a neutral arbiter to settle billing disputes. However, the new bills only include fragile IDR provisions that still prioritize rate-setting by making it law for a full year before an arbiter can step in and correct any payment dispute on behalf of a patient or medical provider. This creates an insurmountable obstacle for hospitals to receive fair payment for the care that they provide to patients, and disproportionately impacts medical providers in rural communities which are already closing at an alarming rate. In recent years, 120 rural hospitals have been forced to shut their doors, decreasing the access to medical care for many of the nation’s poorest and most vulnerable.
If lawmakers in Congress, such as Senate Majority Leader Mitch McConnell (R-KY), want to make a lasting impact that will protect patients and doctors, while also putting a stop to surprise medical bills, it is critical that they observe the overt weakness of this proposal and instead prioritize the passing of a steadfast IDR solution. An arbitration method is one that is championed by our nation's medical professionals who are on the front lines of the COVID-19 pandemic, and also deals a fair hand to insurance providers. In the midst of these troubling times, we must ensure that our nation’s healthcare system is best prepared for the uncertain future, and an Independent Dispute Resolution for surprise medical bills will provide us with a solid foundation.
Ted Alexander is a State Senator representing North Carolina’s 44th District.