Sonji Wilkes learned the hard way that life can still throw you a curve, even when you play by the rules. She had health insurance and the hospital she picked to bring her son into the world was “in-network.”
And, since it accepted her insurance, everything should have been fine. It wasn’t. The Neo-Natal Intensive Care Unit where her baby son was sent due to post-delivery complications was operated by an “out of network” third-party provider with whom her “in-network” hospital had contracted.
Wilkes didn’t know that, not that she really had much of a choice. She ended up - Surprise! - with a $50,000 bill for emergency services.
She’s not alone. Insured patients are being sent, with increasing frequency, from facilities that accept their insurance to those that don’t without being made aware there’s a difference that matters. Some might say it should be an example of “let the buyer beware” but America is a much more generous, compassionate and ethical country for that to be the case here.
Surprise billing, as President Donald Trump and others call it, is a black mark on the world’s finest health care system. Something needs to be done, but there’s a right way to handle it and a wrong way.
The usually reliable Lamar Alexander, chairman of the Senate Health, Education, Labor, and Pensions Committee, is backing the wrong one. His Lower Health Care Costs bill, which has already been passed favorably out of his committee, would cap what insurers need to pay to protect their patients by setting a “median in-network rate” for services.
Rather than ensuring a patient’s surprise bills are covered, Alexander’s legislation empowers insurance companies to cut costs over years by kicking patients’ doctors with the most experience out of their networks.
The health insurance lobby is one of Washington’s most powerful, so it’s no shock this approach is making its way through the Senate. Luckily, the Alexander bill looks dead in the U.S. House -- which may explain why Richard Neal, chairman of the powerful Committee on Ways and Means, is trying an end-run.
Neal recently sent a letter to his fellow Democrats proposing the creation of a committee of stakeholders and representatives from the departments of Health and Human Services, Labor, and Treasury to draft a regulation that would take care of the problem of surprise billing once and for all.
What Neal wants to do is outsource responsibility for finding a solution to the problem of surprise billing to unaccountable, unelected federal bureaucrats. That’s bad news for consumers.
Fortunately, there is a right way, offered on a bi-partisan basis in the Senate by Louisiana Republican Dr. Bill Cassidy and New Hampshire Democrat Maggie Hassan. Their plan taps the power of markets to lower health care costs instead of caving to the demands of insurance industry lobbyists.
The Cassidy/Hassan measure, the STOP Surprise Medical Bills Act, uses arbitration to protect patients. Under its provisions, payers and billers would both submit a fair price estimate for services rendered to a neutral third party who would choose either one price or the other.
Arbitration, when done right, encourages everyone to be fair; if an estimate is outrageously high, for example, it’s likely to be rejected. A similar idea is gaining traction in the House where two doctors, California Democrat Raul Ruiz and Tennessee Republican Phil Roe, are pushing a bill allowing arbitration that most of the physicians in Congress support.
“People who follow the rules and are doing everything right shouldn’t be stuck with sky-high bills,” Sen. Hassan said during a recent discussion at the Bipartisan Policy Center.
The problem is bigger than arbitration alone can solve, but it’s a good start. Working Americans shouldn’t have emergency situations compounded by massive, unexpected medical bills. Lawmakers should be looking for ways, like Cassidy/Hassan, to empower patients and reduce prices across the board. That outcome would be a pleasant surprise for all of us.
Peter Roff is a senior fellow at Frontiers of Freedom and a former U.S. News and World Report contributing editor who appears regularly as a commentator on the One America News network. Email him at RoffColumns@gmail.com. Follow him on Twitter @Peter Roff.