It sounds good, eliminating “surprise” medical bills that patients sometimes receive from hospitals and providers when their services aren’t covered by insurance. This happens sometimes when patients go to a hospital or emergency room and receive services from a doctor who is out of network.
But what if it’s the government stepping in to stop the surprise bills? Government usually messes things up when it gets involved. And even worse, this would open the door to Medicare for All. This is government price controls or rate-setting. One doctor fully admits Medicare for All is the way to fix surprise medical billing. Left-wing billionaire John Arnold, who established the Laura and John Arnold Foundation to support left-wing causes, is pushing this congressional fix.
Several conservative groups oppose the legislation, including FreedomWorks and Club for Growth. The Taxpayers Protection Alliance and the National Taxpayers Union are spending money on ads opposing the bill. Big insurance companies favor the bill.
Doctors oppose it too. Nearly 900 doctors and smaller practices said the proposal could have “devastating unintended consequences” on physicians. In a strongly worded letter to leaders in Congress, they warn that the heavy-handed solution would “severely impact small practices by eliminating what few incentives remain for insurers to negotiate fairly with us, therefore driving further consolidation within health care, and triggering ensuing cost increases.” If this consolidation happens, “health care costs could increase by as much as 30 percent.” It would allow insurers to shift more costs over to patients by using higher deductibles and other cost-sharing measures. CEO William Thorwarth of the American College of Radiology points out that the bill does not prevent insurers from simply keeping any monetary savings to themselves, rather than passing them along to patients. The Federation of American Hospitals says the bill takes two steps forward and three steps back.
According to Beau Rothschild, former outreach director for the Committee on House Administration, doctors and patients are the victims of surprise medical billing. “The insurance companies purposely draw narrow coverage plans and do everything they can to not pay out claims.” Additionally, “patients are given very confusing contracts about coverage that the insurers purposely make very difficult to get reimbursed for care out of coverage.” He says patients shouldn't have to become experts in coverage in order to figure out what will be paid. Doctors are victims because they get blamed for insurance’s deliberately confusing language.
The legislation is offered by one of the most left-leaning members of the Senate, Patty Murray (D-Wash.). Other co-sponsors include Senate HELP Committee Chairman Lamar Alexander (R-Tenn.), Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) and Rep. Greg Walden (R-Ore.).
Rep. Kevin Brady (Texas), the top Republican on the Ways and Means Committee, and Rep. Richard Neal (D-Mass.), the chairman of the Ways and Means Committee, released a competing bill favored by doctors and hospitals. It would ban surprise medical bills, but would let a neutral third party in an independent dispute resolution process determine how much the insurer should pay the doctor if an agreement can’t be made. Some of the conservative groups suppose this alternative legislation, as does the American College of Radiology.
Out of the Middle, a coalition of physicians, says the independent dispute resolution process is working in New York where it has been implemented. According to the New York State Department of Financial Services, IDR has successfully saved consumers $400 million and reduced out-of-network billing 34 percent.
Surprise medical bills are a problem. A study published in the journal Health Affairs found that anesthesiologists, pathologists, radiologists and assistant surgeons at in-network hospitals billed out of network in about 10% of cases. Another study found that over 1 in 5 patients who went to in-network emergency departments were treated by out-of-network emergency physicians.
Unfortunately, the media is not reporting the full picture. Articles like this don’t bother to mention that health care costs for consumers will increase if this type of legislation is passed. That patient who was forced to file bankruptcy due to a surprise medical bill? Now they’ll merely have to file bankruptcy due to costs being increased in other areas. The article explains how Washington state just passed a law ending surprise medical billing. Even if Congress doesn’t pass legislation, some individual states are implementing it. The bill is likely to make it to President Trump. With bipartisan support, there is a real concern that it will make it into law.