Employers, Unions and Health Insurance Providers: Surprise Billing Reforms Can’t Be A Gift To Private Equity

Dec 16, 2020 | Blog Post, Market Approach, Press Release

In a new letter to Congressional leadership, members of the Coalition Against Surprise Medical Billing urged policymakers to prioritize critical “changes to the current bill that would lower costs for consumers, employers and taxpayers.” Highlights are included below:

  • “With millions of Americans still receiving bankrupting surprise medical bills, we appreciate and commend Congress’s commitment to pursuing bipartisan reforms that would protect patients and their families from these egregious charges.”
  • “Federal legislation is badly needed to correct the substantial market failure and close the loopholes that allow certain out-of-network providers, including a significant number backed by private equity firms, to demand a blank check from patients.”
  • “Unfortunately, by relying solely on arbitration, this bill rolls out a red carpet to private equity firms and their lawyers with the intent of making health care even more complicated and burdensome.”
  • “The Congressional Budget Office projected that an arbitration model would add more than $1 billion in administrative fees alone and would raise costs for taxpayers by $5 to $8 billion, as compared to a market-based approach.”
  • “As Congress considers critical legislation to prevent surprise medical billing, we urge you to prioritize changes to this bill that would lower costs for consumers, employers and taxpayers. Specifically, we request the legislation be modified to:
    • Include an interim payment for out-of-network services based on competitively negotiated, market-based payments between health insurance providers and other doctors and specialists in the local market – a proposal supported by an overwhelming majority (nearly 80 percent) of voters.
    • Include a threshold amount below which claims are not eligible for burdensome arbitration – as one way to limit private-equity firms abusing arbitration.
    • Include an unequivocal prohibition on providers submitting billed charges – which studies have shown can be over 2600% of what Medicare pays for similar services.”
  • “Now, more than ever, as we forge ahead during a global pandemic, Americans need health care costs to decrease – and these changes we have outlined are critical to saving billions of dollars for employers, patients, and taxpayers. We urge you to strengthen this bill for millions of Americans by incorporating the changes we have proposed.”

To view the full letter, click here.