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Bill Cassidy

Matt Glazer: A way to end surprise medical bills

(Note: The following is a guest post that was submitted to me. I occasionally solicit guest posts, and also occasionally accept them from people I trust.)

At a young age, I had to deal with medical issue after medical issue. It started with trips to M.D. Anderson and ended with an emergency appendectomy. Three major illnesses in 2 years was hard, but we were fortunate enough not to be financially destroyed by these unexpected medical expenses.

Fast forward to now and I am constantly nervous to go see a doctor. Yes, I have insurance now (something that was impossible before the Affordable Care Act), but I am also a pawn in a subterranean fight between health care providers and insurance companies. Basic treatments that should be covered sometimes aren’t and with no rhyme or reason. Then I am hit with unexpected bill that sends me back to eating ramen or cutting expenses again.

There is a real, bi-partisan opportunity to do something about this and protect consumers.

As COVID-19 continues to disrupt life in Texas throughout the country, health care access has never been more important. Now more than ever, people need to see a doctor when they’re sick – not just for their own health, but (given the contagiousness of the disease) for the health of those around them.

Yet some in Washington, D.C. are putting that access at risk in a ham-fisted attempt to stop surprise medical bills.

Most of us have dealt with the shock of a surprise medical bill in recent years – those charges you get billed for after getting medical care, when your insurance company refuses to foot the bill for an out-of-network health provider. Congress has been debating this issue for over a year, and two main camps have emerged. One group wants to end these disputes by creating an independent dispute resolution (IDR) system, where providers and insurance companies are pushed toward a negotiating table to figure out their differences, and patients are left out of the process. The other group wants pre-determined reimbursement rates for services based on insurance companies’ in-network rates.

The first option, IDR, is similar to what we passed last year for insurance plans regulated by the state of Texas – one of the country’s most patient-friendly surprise medical bill laws which won bipartisan support. Other states, such as New York, have instituted a similar system with successful results. (Unfortunately, these state fixes only apply to plans regulated by the state, which is why Congress needs to act. For example, in Texas only 16% of health plans are covered by the state surprise billing law.)

The problems with the second option become obvious quickly: If insurance companies are setting rates, they have all the negotiating leverage. Surprise bills go from being a dispute over how much to charge for a medical procedure to a take-it-or-leave it edict to hospitals, doctors, and other care providers. The rate-setting option would artificially drive insurance payouts down and create dire financial situations for doctors and hospitals – particularly in rural areas, where hospitals function as major hubs for local health care services. It would pad the bottom line for health insurance companies, though – not like they need it, since they have been among the few companies making more money during the pandemic.

Worst of all: Rate-setting would allow insurance companies to further enrich themselves on the backs of the doctors, nurses, and other health care providers who have been serving on the front lines of the pandemic, shouldering more risk than any of us in fighting COVID-19.

(Last month, the Trump administration proposed a third option: an outright ban on surprise medical bills with no outline for resolving the underlying dispute. That figures to throw any disputed bill into the court system, with costly lawsuits driving up the costs of both health care and insurance premiums. Everyone except the lawyers would lose in that scenario.)

Thankfully, surprise medical billing is one of the few truly bipartisan issues on Congress’s agenda, outside the drama of November’s elections. And there is bipartisan support for an IDR-based solution, which means that we can have some hope that Sen. John Cornyn, Sen. Ted Cruz, and the rest of our Congressional delegation will step up and do the right thing. And there are legislative options, put forward by members of Congress who are actual doctors: Sen. Bill Cassidy (R-La.) has more than 30 bipartisan co-sponsors for his “STOP Surprise Medical Bills Act,” and more than 110 House members have similarly signed on to the “Protecting People from Surprise Medical Bills Act,” sponsored by Rep. Phil Roe (R-Tenn.) and Rep. Raul Ruiz (D-Ca.). Both of these bills solve surprise medical bills using IDR and keep the patients out of it.

We still have a long way to go in facing COVID-19 pandemic. During this time, and the time to come after, one thing should be crystal clear: We cannot make it harder for people to get health care when they need it. Access to health care will be essential as the economy struggles to recover in fits and starts, we need workers and customers who don’t have to worry about finding care if they get sick.

Forcing doctors out of business and pushing hospitals to the brink of financial collapse is no way to fight a pandemic – or to help patients.

This is a necessary solution for millions. A generation later, I am still terrified to go see a doctor because of the uncertainty surrounding every trip. I am still affected by the bad luck I was afflicted with before I could drive a car, vote, or serve our country. A generation later, I still feel the effects of being a pawn in a game I don’t want to play. There is a real opportunity to do something about this now. All it takes is for our elected officials to do it.

Matt Glazer is the past Executive Director of Progress Texas and co-founder of Blue Sky Partners.