COVID-19 has caused an unprecedented crisis in America’s health care system. More than 110,000 Americans have died while millions have been tested and isolated themselves from friends and family. But even as doctors and providers continue to battle the virus on the frontlines, large health insurance companies are spending millions of dollars lobbying Congress for legislation that would lead to doctor shortages and increase their already record profits.
Surprise medical bills occur when insurance companies pass costs onto patients who expect their plan will cover the care they received. This can take the form of higher co-pays and deductibles. In many cases, insurers even refuse to cover the full cost of medical treatments. A 2018 survey found that more than 50% of American adults have received an unexpected bill for medical care they believed was covered by their health insurance. Here in Utah, more than 15% of people who are taken to the ER end up with out-of-network services for which they could be personally billed after they are stabilized.
Congress recently passed a law requiring insurance companies to cover COVID tests without charging patients for cost-sharing measures like copays and deductibles. But large health insurers continue to exploit the pandemic by sending surprise bills to vulnerable patients.
Sen. Lamar Alexander, R-Tenn., and Rep. Frank Pallone, D-N.J., have introduced legislation that would give insurance companies the power to impose a 20% pay cut on frontline medical professionals. If doctors refuse this rate-cut, insurers use their market power to kick doctors out of their network.
Sen. Alexander and Rep. Pallone’s proposal was misguided before COVID-19. It’s reckless during a pandemic. Their legislation would lower the reimbursements that hospitals, physicians and emergency care providers depend on. If passed, hospitals, clinics and other health care providers could shut their doors, especially in underserved and rural communities.
Health insurance companies are the most profitable entities in our health care system and continue to post record earnings during a pandemic. Yet insurers continue to surprise patients with bills. Some insurers have even spent millions lobbying Congress for this rate-setting legislation that would release them of their obligation to work with doctors to preserve America’s health care safety net.
There are better solutions to solve surprise medical billing that don’t put the nation’s health care safety net or patients’ access to care at risk.
Fortunately, Sen. Bill Cassidy, R-La., has introduced legislation that ends the practice of surprise medical billing by establishing an independent dispute resolution process for insurers and providers to work out billing disputes. Independent dispute resolution has proven successful at the state level because it empowers an independent mediator to determine a fair price when insurers and physicians cannot. Patients are kept out of the middle of the process. The IDR model is based on successful processes implemented in New York and Texas.
Sen. Cassidy’s legislation has more than 30 bipartisan cosponsors in the Senate, while similar legislation in the House is supported by more than 110 members of both parties. I encourage Sens. Lee and Romney to join their colleagues and cosponsor this thoughtful and meaningful bill.
The Trump administration should follow Sen. Cassidy’s leadership and support his solution to surprise medical billing. However, the White House has instead decided to release their own plan that doesn’t create a mechanism for insurers and doctors to mediate their billing dispute and allows insurance companies to keep their negotiating power. The proposal is a major win for trial lawyers, since insurers and providers will continue to sue each other over disputes. As a result, insurers will pass more costs onto patients, in the form of copays and deductibles, to cover the cost of litigation.
The COVID-19 pandemic has exposed the true intentions of large health insurance companies. Congress must act to protect patients and doctors, not give insurers more power to protect their own profits.
Dr. Locke Ettinger is the director of the Rural Health Association of Utah.