Surprise Medical Bills Won’t Go Away Unless Congress Acts

Editorial

In my decades-long career in medicine, I have never seen a worse example of industrywide price gouging than surprise medical bills. These are expensive medical bills that patients receive when they are treated at a hospital or by a medical practitioner that is outside of their insurance's network of authorized health care providers.

A hospital, for example, can charge an out-of-network patient more for its services because they aren't tied to any agreement with their insurance company. But, in emergencies, patients don't have time to run through every doctor at the hospital to make sure that they are in-network. And rural communities, where I worked for 17 years, hardly have any options in health care providers, and existing ones are disappearing every year.

Many patients are unaware of the network distinctions and assume that their insurance plans cover their hospital visits. This is a common misconception. In fact, one in six insured hospital patients received a surprise medical bill in 2017. In nearly every case, these bills caught patients off guard: seven out of 10 Americans who received one didn't know that their provider was out-of-network.

Americans, sinking in rising medical debt, asked their representatives to end surprise bills. Now, Congress is deciding between three possible solutions to the issue.

In May, Sen. Bill Cassidy, R-La., a longtime doctor, introduced the STOP Surprise Medical Bills Act. Under the STOP Act, patients would be protected from out-of-network charges in emergency situations. Their network statuses no longer would matter.

The STOP Act also would give patients access to out-of-network medical specialists. While I have always tried to choose the best specialists for my patients, some doctors have had to choose from a narrow set of in-network specialists for their patients. In many cases, this has led to suboptimal treatment. The STOP Act corrects this problem.

In short, the STOP Act is the best solution for patients.

Congress, however, also is weighing Rep. Richard Neal's proposal to have the government establish fixed prices for medical services. But, whenever Congress has attempted to do this, it has resulted in unanticipated consequences.

For example, when Medicare price fixing was implemented, many rural physicians who once prided themselves in being independent moved to cities and joined large medical centers as employees, as dealing with bureaucracy and endless paperwork would have been too time-consuming and difficult for small practices - resulting, ultimately, in fewer options for rural communities.

Plus, Washington policymakers decided urban physicians should be paid more than rural physicians for the same services, sometimes double the amount, which further incentivized rural physicians to migrate to cities.

And, under Obamacare, lawmakers promised patients better access to medical services without having to pay more in taxes. Instead, Congress shrank access by decreasing Medicare payments, which threatened to create further shortages in rural facilities and providers.

In other words, history proves that government price-fixing doesn't work.

The third option is using an end-of-the-year funding bill to end surprise bills. But an opaque funding bill that sneaks through a toothless fix won't work. Instead, a single bill that the public can read is what is needed to end surprise bills.

Fortunately, our Nebraska Congress members have great political influence in Washington and can help end surprise medical bills. By supporting the STOP Act, they, along with lawmakers on both sides of the aisle, can protect patients from surprise medical bills.