In an op-ed for the National Review, Senate HELP Committee Chairman Lamar Alexander makes the case for why Congress needs to step in to correct the market failure that contributes to surprise medical billing – one of the “most visible health-care problems for the 200 million Americans who have insurance through their jobs or on the individual market.”

Solving the issue of surprise medical bills must address the root of the problem – the exorbitant bill from out-of-network providers who choose to demand a blank check from patients. By implementing a fair benchmark standard that was central to the Senate HELP Committee’s Lower Health Care Costs Act, Congress would save patients and taxpayers more than $25 billion over ten years. Highlights from the op-ed are included below:

  • “Last year, Todd, a Knoxville father, wrote to me after taking his son to an emergency room after a bicycle accident. His son was treated, Todd paid a $150 copay because the emergency room was ‘in-network’ for his health insurance, and they headed home. So Todd was surprised when he received a bill later for $1,800 — because even though the emergency room was ‘in-network,’ the doctor who treated his son was not.
  • “One in five in-network emergency-room visits result in the patient receiving a surprise medical bill like Todd’s. Across the country, patients are being hit up for hundreds or thousands of dollars, months after they received care, because doctors they didn’t even choose were outside their insurance networks.”
  • “Last month, the Senate’s health committee passed the Lower Health Care Costs Act, by a vote of 20–3, to end this practice. Here’s how it works. Insurance companies already negotiate with doctors, hospitals, and other health-care providers to establish in-network, market-based rates.”
  • “Under the bill, providers who don’t join insurance networks would be paid the median, or middle, amount set in each local market. The Congressional Budget Office estimates this approach would save taxpayers $25 billion over the next ten years.
  • This is a proposal targeted at a small number of doctors — less than 5 percent — who liberal and conservative economists alike (from Zack Cooper at Yale, to Loren Adler at Brookings, to Ben Ippolito at the American Enterprise Institute) have found are intentionally staying out of insurance networks so they can charge patients exorbitant prices.”
  • “This legislation does not allow the federal government to set rates. Nor can insurance companies unilaterally set rates. The market will set a price that reflects the cost of providing care in that area.
  • “Some believe that the federal government should instead establish a new system of third-party arbitration for settling billing disputes. Others would have the government pick one rate and then increase that every year by adjusting for inflation, even if health-care costs decrease. I believe the Senate’s solution, which protects patients and empowers local markets to determine the price of health care, is the best way forward.”
  • “It is time for Congress to take action to protect patients from surprise medical bills, and I believe the approach in the Lower Health Care Costs Act is the least intrusive, most market-driven, most effective way to do so.”

To view the full op-ed, click here.