There are many reasons why Congress should put an end to surprise medical billing. Here are the three most important.
Amidst a global public health crisis, Congress has yet to take comprehensive action to address one of the biggest health and affordability challenges facing millions of Americans: surprise medical billing. Despite temporary stop-gap regulations, patients and their families still face the serious threat of a surprise medical bill from out-of-network providers and private equity firms. There’s a long list of reasons why Congress should take action now to safeguard families from these unfair charges. Here’s just a few:
- Loopholes in COVID relief legislation and regulatory guidance give out-of-network providers and private equity firms an easy pass to balance bill patients. The Trump Administration established common-sense guardrails for providers that accepted federal funding as part of the COVID relief packages – and the HEROES Act takes that guidance a step further by incorporating those provisions into potential federal law. However, even those policies have significant limitations. For example, they don’t apply if a provider or private equity-backed staffing firm chooses to forego federal funding, leaving many patients still at risk for a surprise medical bill, especially if they receive non-COVID related care from an out-of-network provider in the midst of the pandemic. Case in point: recent coverage in Bloomberg highlights how some private equity-backed providers are still looking to take advantage of patients.
- The cost of COVID-related care continues to increase, raising concerns about an unprecedented affordability crisis. Even before the COVID-19 crisis, two-thirds of Americans were worried about being able to afford an unexpected medical bill. The risk of an unfair, bankrupting medical bill is real – even today, Americans face the risk of a bill from an out-of-network provider during an emergency, during surgery, and even during a stay at an in-network hospital. The COVID crisis exacerbates those financial fears – the estimated cost of coronavirus in-patient treatment for an individual patient is more than $20,000, according to the Kaiser Family Foundation. For patients in “hotspots” across the country where COVID cases continue to surge, the range in costs associated with hospital stays will leave a disproportionate financial burden on the most vulnerable Americans.
- The best way to protect patients and American workers from future outbreaks or pandemics is to put essential safeguards in place now that allow us to focus on strengthening our response in the future. Establishing fair, market-based rates for out-of-network reimbursement ensures that all Americans can benefit from negotiated rates for essential medical care. It also extends vital protections against surprise medical bills during unexpected emergencies and for care provided at an in-network hospital. Both of these critical steps can put our health system and the country on stronger footing to make sure that we are delivering on our number one priority – getting patients and their families the critical care that they need at just the right time. Plus – delivering $25 billion in savings back to taxpayers, employers and families – as opposed to private equity firms – is the right thing to do on behalf of millions of Americans and patients.