by Reps. Susan Lynn and John J. DeBerry Jr.
The rising cost of health care in this country puts millions of Americans at risk. One of the many issues that Congress can and should address to help improve this situation is to eliminate surprise medical billing once and for all.
However, as they work to pass legislation on this issue, Congress must ensure that whatever solution they enact does not lead to adverse, unintended consequences for patients or our health care system.
Surprise medical billing happens when a patient receives out-of-network care without their knowledge – either in an emergency situation or during a visit to an in-network facility if they are treated by a physician that is not in their network – and weeks later, receives a bill from their insurance company for care they thought would be covered.
This added stress and financial burden is something no one should have to go through. Surprise medical billing is not a partisan issue – it impacts Republicans just as much as Democrats – and it is time for both parties to come together in Congress to pass a lasting solution to this growing problem.
Some of the proposed solutions to end surprise billing – including S. 1895, the Lower Health Care Costs Act introduced by Sen. Lamar Alexander – employ a dangerous proposal known as “benchmarking.” This approach would permit the federal government to set payment rates for doctors performing out-of-network care across the country. In doing so, benchmarking opens a can of worms that would ultimately threaten health care for millions of people.
This form of government rate-setting would be particularly harmful for hospitals, clinics, and emergency rooms serving Tennessee’s hard-to-reach rural patients as well as underserved urban communities. Allowing the government to dictate provider reimbursement rates – and to set arbitrarily low ones at that – would lead to many doctors being underpaid for the services they provide. America’s hospitals and other health care centers would be forced to contend with billions of dollars in losses.
Many of these facilities are already struggling to keep their doors open as it is, particularly those serving some of our state’s most vulnerable patients in rural and urban areas alike – including uninsured, Medicaid, or Medicare patients. This could lead to more hospitals closing down or consolidating, either of which would mean fewer options, increased burdens, higher prices, longer wait times, and a diminished quality of care for Tennessee patients.
These outcomes should be unacceptable to our elected officials in Congress, regardless of political affiliation.
There are, however, more workable solutions in Congress that would protect patients from surprise medical billing without jeopardizing health care for anyone. Instead of benchmarking, these proposals call for an Independent Dispute Resolution to shield patients from being caught in the middle of a billing dispute between providers and insurers.
IDR establishes a balanced billing negotiation process that encourages transparency and fairness, allowing both parties to submit their best “offer” through an online portal. In 30 days or less, a final payment is determined by an impartial, third-party mediator.
IDR is the only solution in Congress that has been proven to work. New York implemented the process back in 2015 to protect patients there from surprise billing – and since then, in-network rates have increased as out-of-network ones have decreased, all while not impacting the cost or quality of care in emergency room settings. This is the model that Congress should seek to replicate.
We are very grateful to Sen. Marsha Blackburn and Rep. Phil Roe for supporting the IDR process – and we urge Sen. Alexander to ensure the final version of S. 1895 includes the tried-and-true IDR process instead of the potentially harmful benchmarking approach it currently includes.
(Republican Susan Lynn represents Tennessee House District 57; Democrat John J. DeBerry Jr. represents District 90.)