We all agree that ending the unfair practice of “surprise billing” needs to be an urgent priority for Congressional leaders and the Trump administration.
For too long, too many patients have been saddled with medical bills they didn’t expect at prices they can’t afford. According to one recent survey, more than 4 in 10 insured adults say they have received a surprise medical bill from an out-of-network provider in the past two years alone.
While closing the loophole that allows out-of-network providers to charge patients exorbitant rates at in-network facilities is a critical first step, creating a new system that ensures fairness for all — patients, providers and taxpayers — is just as vital. Only taking the “surprise” out of surprise billing is not enough. Truly addressing the problem requires setting a reasonable and fair payment benchmark for health care providers who choose to remain out-network.
Congress is currently considering a variety of fixes to end surprise billing. While some of these proposals would require health insurance providers to reimburse non-participating doctors based on a fair benchmark standard that reflects the actual cost of care provided in their community, others would mandate an expensive arbitration process between health plans and providers.
While this may seem like a small, technical distinction, the potential impacts are massive.
Arbitration is an expensive, time-consuming, and convoluted process that does nothing to address the core problem at the heart of surprise medical billing: the inflated bill itself. In reality, it’s just a new bureaucratic forum for fingerpointing at a time when we need real solutions. Forcing this arbitration process into reforms that are intended to save patients, consumers, and taxpayers money would actually have the opposite effect.
This isn’t just speculation. According to initial estimates from the Congressional Budget Office (CBO), an arbitration proposal would cost consumers and taxpayers between $5 and $8 billion over the next ten years. Those costs will ultimately show up in consumers’ premiums. And for small businesses, the cost impact will be seen immediately and could be prohibitive. This system creates more red tape for American small businesses, raising their costs and placing new obstacles to them providing health coverage.
The problem is that surprise medical bills are often based on little more than what a non-network provider hopes to be paid. Under arbitration, these excessive charges are weighted equally to reasonably negotiated rates. The process, therefore, rewards these outrageous charges, resulting in payments that are excessively high and increased premiums for patients.
But that’s not all. Because the federal government provides premium tax credits to help reduce health care costs, rising premiums for patients means rising costs for taxpayers.
Ending surprise billing represents a tremendous opportunity for policymakers to come together to pass meaningful reform that protects patients and builds a fairer system for all.
But the devil is in the details.
The CBO report is an important reminder that any proposal which introduces an inefficient and unfair arbitration process not only fails to protect patients but may even make things worse.