Bloomberg’s editorial board weighs in on value of a local, market-based benchmark to end surprise medical billing for good.

Congress Can Act Now to Stop Surprise Medical Bills
Many health-care questions are difficult and divisive. This one shouldn’t be.
By The Editorial Board, Bloomberg
October 1, 2019

While most of Washington was on vacation in August, lobbyists for doctors were busy placing ads attacking the recent effort in Congress to end “surprise medical bills” — the practice of slapping unsuspecting patients with huge out-of-pocket charges they couldn’t see coming. The blitz might be working. Before the summer recess, committees in each chamber had approved bipartisan bills to address the problem. But Senate Majority Leader Mitch McConnell is silent on whether he’ll bring the legislation to a vote, and it seems this necessary reform might not happen after all.

Many health-care questions are complicated and controversial, and reasonable people can disagree on what’s best. This isn’t one of those questions. Many emergency-room doctors deliberately stay out-of-network so they can charge sky-high prices. Patients get whacked after the fact, discovering that even though their hospital was in-network, their treatment wasn’t. In 2017, the practice is estimated to have affected charges for 18 percent of emergency visits covered by large-employer insurance plans. And it isn’t confined to emergency-room visits. Sometimes in-network hospitals use out-of-network doctors for non-emergency treatments and pass on the higher costs to their unsuspecting patients. It’s indefensible and should be stopped.

Some states have taken steps to rein in the abuse, but Congress needs to act immediately to protect the 61 percent of privately insured workers whose employers operate their health plans directly and aren’t covered by state regulations. A good approach, set forth in both House and Senate versions of proposed legislation, is to link the cost of medical services in emergencies or at in-network facilities to a benchmark, regardless of whether the doctor concerned is in- or out-of-network. Exactly what the benchmark should be and which disputes, if any, should be settled via arbitration are points on which the different versions will need to be reconciled, but the basic idea is correct: Patients should be shielded from being ambushed by enormous charges.

Critics of the legislation argue that limiting what doctors can charge will result in fewer doctors, services and hospitals. They want all such disputes to be handled through arbitration. The costs and complexities introduced by relying entirely on that approach make it very unattractive. The essential point is that disputes over surprise billing shouldn’t be arising in the first place.

California has seen some success in curbing surprise medical bills and putting patients back in the picture when it comes to choosing and paying for their treatments. The problem is readily solvable, provided Congress summons the will. Lawmakers in both parties who have backed this legislation need to step up their efforts and insist that their respective leaders act on the issue this year.

To view the full editorial, click here.