The Proven Solution to Ending Surprise Medical Bills

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Emergency rooms can be landmines. If you get treated by a doctor that isn’t in your insurance network, there will be a hefty surprise medical bill waiting to ambush you when you check the mail. Usually, insurers are the best line of defense against hospital bills. But they don’t cover out-of-network bills. They tag you to deal with much of the cost, which can be in the tens of thousands of dollars. Insurers have done this so often that 81 percent of Americans now blame them for surprise bills.


For example, Amy Brooks, a 50-year-old Wisconsinite who works seasonal jobs, faced a $41,000 surprise medical bill after she was flown to a hospital to treat her seizures. Amy said she “felt helpless” when she found out that her insurer passed the bill onto her. She had a modest income and the five-digit bill would have driven her straight into bankruptcy. But she sued her health insurance company and won, freeing her from having to pay.


While she was lucky, others weren’t.


Phil Gaimon was rushed by ambulance to the nearest hospital after he fractured his collarbone and ribs in a cycling accident. That hospital, however, was outside of his insurance network. But Phil, who was in and out of consciousness, couldn’t shop for an in-network hospital. The bruised cyclist needed to see a doctor fast. But this reasonable explanation for having to go to an out-of-network hospital didn’t draw any empathy from his insurance company. It chained him to a $250,000 bill. “I was making no decisions, I was on drugs, and in fetal-position-level pain. Every decision was made to live. And then you emerge and you’re financially ruined,” Phil said after receiving the bill.


Amy and Phil are part of the 44 percent of Americans who have received a surprise medical bill—and the 94 percent of voters who want Congress to end them. A new plan by Representatives Richard Neal and Kevin Brady could protect patients by creating a system that would allow doctors and insurers to negotiate a surprise bill before independent arbitrators. With independent arbitration, patients would be taken out of the process and can relax knowing that they are covered. This is why arbitration, which has worked in New York and Texas, is backed by nearly 70 percent of voters.


On the other hand, insurer-backed proposals in Congress wouldn’t stop surprise bills from piling up in patients’ mailboxes. Rep. Frank Pallone introduced a bill that would have the government set medical rates, which insurers spent $50 million lobbying for. Pallone is protecting insurance profits, but not patients, who polls show oppose his so-called “solution.” It leaves patients stuck in the middle, having to navigate their insurers’ windy appeal processes.


In fact, California tried Pallone’s idea; now, nearly 70 percent of patients don’t have access to timely medical care. And, if it’s bad in America’s most populous state, it’ll be worse for small, rural communities, where doctor shortages have made it tough for many patients to find medical care. Insurers will drive government rates so low that rural hospitals wouldn’t be able to stay in business. Take a look at rural nursing homes, which couldn’t survive the government’s rate-setting onslaught in Nebraska. And, if Pallone’s bill passes, it would be the first step to Medicare for All, which requires the government to first have the power to dictate private medical rates.


However, the insurance industry may target Neal and Brady, and push them to adopt Pallone’s type of government rate-setting to their plan. But a mixed solution of soft rate-setting and arbitration muddies the water and wouldn’t end the problem. In fact, it could make the problem worse.


I hope that rock-solid conservatives who represent rural areas, like Representatives George Holding and Ken Buck, support arbitration over government rate setting to stop surprise medical bills. It will end surprise medical bills, and, at the same time, protect our rural health care providers and patients.

Jesse Grady is a former staff member for President Donald Trump’s 2016 campaign.

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