Congress Should Stand Up to Big Insurance on Surprise Billing Legislation

Republicans and Democrats on Capitol Hill are quietly working toward what could be one of the biggest health care decisions since Obamacare: a measure to end surprise billing. The only question is, will the solution further expand the power of the government and big insurance companies, or will it be a market-centered approach (for once) that benefits patients? America’s emergency health care services may be one of many factors that hang in the balance.

There is little disagreement that the problem exists. Many of us have seen it ourselves: We receive emergency care at a facility not necessarily of our choosing. We assume our health insurance will have our backs in this hour of need, only to open the mailbox weeks later and find a bill for thousands of dollars.

These surprise bills are caused by insurance companies setting increasingly narrow networks to cut costs. Often one of the first services to get cut is life-saving emergency care. Insurers not only remove hospitals from networks but also doctors, often without patients’ knowledge. This means that even if you receive care at an in-network hospital, all physicians who treat you on-site will not necessarily be in-network. When one isn’t, your insurer and provider try to work out a price, and if they can’t, you ultimately get stuck with a surprise bill. Quite a system, isn’t it?

Legislators are debating several solutions to the problem. The Senate is favoring legislation that would settle reimbursement rates for out-of-network care using median rates for in-network care, also known as a benchmark rate solution. This would be a boon for the insurance industry, which is already seeing its highest profits in at least 10 years.  The benchmark rate amounts to the government stepping in to the market on the side of big insurers, vesting them with extraordinary power to set their own prices, which would almost certainly slash provider pay.

What happens when you slash pay for doctors, physicians, and emergency facilities? Just ask California. Two years after it instituted a statewide rate-fixing plan, doctor shortages are approaching crisis levels, particularly in rural areas. Giving insurance companies more authority to deflate payments nationally will make it extremely difficult for emergency departments to maintain the high costs of operating a 24-hour, seven day a week practice, especially in underserved communities.

There is a better way to end surprise billing. Congress should institute a fair arbitration process to resolve payment disputes between providers and insurers for out of network care. Regardless of the arbitrator’s decision, the patient still only owes the in-network rate. This model was tried in New York to great effect, and Texas recently instituted a similar system. The solution is a win-win-win: it eliminates surprise bills for patients, ensures physicians and emergency health care providers are fairly compensated, and still prevents insurance companies from collapsing under massive costs.

With Congress now in its August recess, several strong conservatives such as Sen. Bill Cassidy of Louisiana and Congressman Phil Roe of Tennessee are working overtime to sway the debate in favor of arbitration over the benchmark rate. Other conservatives, such as Leader Kevin McCarthy, should get behind them. It’s high time that Congress favors a market-centered approach that actually improves the greatest health care system in the world, including by ensuring accessible care when we need it most.

Plus, with the 2020 elections looming, what better time to prove to the American people that it’s the Republican Party, despite what they may have heard, that holds the keys to a brighter health care future?