Big Insurance Must Help End Surprise Medical Billing
February 25, 2020
By: Benjamin F. Chavis, Jr.
(The Charleston Chronicle) — It is a serious financial problem that far too many African Americans – from impoverished individuals to working-class families — face these days in the bewilderingly complicated health-care market: Getting hit with an unexpected bill after a hospital stay or visit to the emergency room.
Known as “surprise medical billing,” these unexpected costs arise when a patient goes to a hospital for emergency or non-emergency care, only to find out afterwards that one of the medical providers who administered care was not covered in the patient’s insurance network.
This outrageous situation benefits one group and one group alone: powerful insurance executives, who have managed to get off the financial hook for such bills, even as insurers shrink insurance coverage networks to wring more and more profits out of the system.
But this predatory practice is overwhelming to a family already dealing with the emotional and financial burdens of a medical crisis, typically adding thousands of dollars in unexpected expenses that can wipe out savings accounts or otherwise strain tight household budgets.
So, what can be done to stop and end surprise medical billing?
The good news is that both Republicans and Democrats in Congress agree that legislation is needed to protect patients against unexpected medical charges. But as with many complicated issues confronting Congress, lawmakers have been divided on the details of such legislation.
Part of the paralysis in Congress stems from confusion and disinformation, as insurance executives and their allies try to frame the debate to their advantage.
When Congress tried to address the issue last year, for example, the insurance lobbying machine swung into action, attempting to place the blame for surprise bills on out-of-network medical providers who end up having to charge patients when insurers refuse to cover a medical bill.
Big insurance almost got its way in that legislative debate when a handful of lawmakers threw support behind a legislative proposal that would shield insurance companies from paying what they ought to pay. The legislation, championed by Sen. Lamar Alexander (R-Tenn.), specifically called for setting benchmarked rates for out-of-network medical providers.
But far from solving the problem, this approach would make matters worse. It not only frees insurers from their responsibilities. It fails to compensate providers for the cost of the care that they actually provide. And that, in turn, means either patients will get stuck with the bill or medical providers will have to absorb big losses that ultimately jeopardize their ability to stay in business.
Fortunately, the proposed bill stalled after the medical community warned that the benchmarked rate favored by the insurance industry would allow insurers to exert a new troubling level of control over health-care prices and the larger health-care delivery system.
Now, as Congress begins to take up the issue once again, health insurance companies that evaded significant scrutiny last year seem to be drawing close scrutiny now, both inside and outside of Washington.
Speaking to a group of faith leaders and policymakers in South Carolina, an important stop for the 2020 Democratic presidential primary, Reverend Al Sharpton criticized the surprise medical billing legislation backed by insurers and stressed the urgent need to deal with the continued lack of access to adequate health insurance coverage for minority communities.
“Washington is getting it wrong,” he wrote in an opinion piece published after his South Carolina trip, adding that the bill introduced by “Sen. Lamar Alexander (R-Tenn.) to `solve’ the surprise billing problem would literally insulate insurance companies from covering these costs, at a time when profits for insurance companies have reached record highs.”
In the U.S. House of Representatives, Ways and Means Committee Chairman Richard Neal (D-Ma.) predicted that health insurers would do little more than look out for their own interest if they were given the authority to set rates for out-of-network providers.
“My concern with giving too much weight to such a benchmark rate is that we already know insurers are looking for any way they can to pay the least amount possible,” he said. “They will work to push those rates down, regardless of what it means for community providers like physicians, hospitals, and our constituents who they employ.”
There were similar concerns in the U.S. Senate, where Senator Bill Cassidy (R-La.) warned that insurers began gaming the system in California once benchmarking rates became the law of the land in that state in 2016.
“Insurance companies cancel contracts and then they have the negotiating power and they establish” their own rate, he said, adding that such benchmarking of rates would likely put hospitals “out of business.”
It’s worth noting that lawmakers are raising such concerns despite the considerable backing the insurance-industry legislation has had from two powerful lawmakers: Senator Alexander, chairman of the Senate Committee on Health, Education, Labor, and Pensions; and Frank Pallone, the chairman of the House Energy and Commerce Committee, whose jurisdiction includes health care issues.
More than that, Senator Cassidy introduced legislation that would eliminate surprise medical billing by establishing an arbitration system between insurers and providers — rather than sticking the disputed medical charges to patients. And that legislation is gaining strong bipartisan support, as is a similar bill in the House that is being advanced Representative Phil Roe (R-TN) and Representative Raul Ruiz (D-CA), both of whom are doctors.
Surprise medical billing is a problem we can no longer ignore, particularly at a time when roughly two-thirds of Americans say that they are concerned about their ability to pay for an unexpected medical expense for themselves or for a family member. And this practice it is especially hard on African Americans and other people of color in the U.S. who already face significant barriers to health care and who generally receive lower quality of care than the rest of the nation.
Congress has an opportunity to make things right by ending the practice of surprise medical billing. Black Americans and all others in America shouldn’t be saddled with exorbitant bills that they had no reason to expect – and that impose an unjust financial burden.