Surprise medical bills are bankrupting patients, and it’s on us to stop it

December 6, 2019

It’s easy to chalk up stalled bills and ineffective legislatures to modern day partisan toxicity- but when it comes to surprise medical billing, that would be an inaccurate assessment.

 

While health care remains a divisive political issue heading into the 2020 elections, both Democrats and Republicans in Congress appeared to be united in the effort this year to end surprise medical billing, a practice which leaves unsuspecting patients with thousands of dollars in medical bills even when they have insurance. Despite this bipartisan agreement, a federal bill has yet to pass or go into effect.

 

The multi-million dollar elephant in the room is privately backed physician staffing firms. These firms began a mass lobbying effort in the third quarter to stall legislation aimed at stopping surprise billing.

 

A little-known aspect of the United States’ for-profit health care system includes private physician staffing firms that contract with hospitals and emergency rooms. These contract doctors- most often emergency room physicians, radiologists, or anesthesiologists,  often turn out to be out-of-network providers to patients even when the hospital they visit is in-network. Falling under their care, even for mere minutes, can ramp up thousands of dollars of medical bills that patients can’t afford and shouldn’t have to pay.

 

A coalition of these staffing firms called Physicians for Fair Coverage spent $4.1 million in the third quarter on lobbying efforts to stall a House bill, the Lower Health Care Costs Act , that would set the rate, known as “benchmarking”, insurers would pay out of network doctors.

 

While that’s a huge lobbying effort, they are not alone, and other similar groups are after the same outcome. A similar group called Doctor Patient Unity poured $28 million into a lobbying campaign with the same goal, according to Open Secrets.

 

A different potential remedy outlined in a House bill is third party arbitration over cost disputes. Lobbying efforts by Physicians for Fair Coverage and other similar groups favor using arbitration to determine how much insurers must pay the out of network providers.

 

Health Affairs, a peer reviewed journal of health policy and research, reports that bills that favor arbitration raise great concern, because they use already-too-high charges as their baseline. Those rates are largely unconstrained by market forces and are therefore unfair to consumers.

 

Health Affairs reported that by contrast, the benchmarking approach proposed by the House Energy and Commerce Committee and passed with bipartisan support  by the Senate’s Health, Education, Labor, and Pensions Committee would reduce premiums on average by 1 percent nationwide, and decrease deficits by $25 billion over 10 years. The benchmark rate would be much lower than a rate set through arbitration, period.

 

Using an arbiter allows for higher profit margins for these groups. Backed by private equity, they have money to burn when it comes to lobbying, but the public will suffer if they achieve their goals.

 

That’s why consumers need to make their support for a benchmarking approach known to their senators and congress people. We need to band together to send a message to our representatives that we don’t want arbitration deciding our medical bills, and we need them to stand up to these staffing firms once and for all.

 

You can use this handy link to find your representatives and their contact information, that way you can let them know that you would prefer them to support a benchmarking approach to surprise medical billing.

 

For more about the senate bill, click here.

For more information on the house bill, click here. 

To read more about the mass lobbying effort against a fair solution to surprise medical bills, click here.

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