Congress should move now to ban surprise medical bills

Donald Bryson
·3 min read

The election may be over, but President Trump and members of Congress still have work to do before Joe Biden takes office and a new session of Congress begins.

In September, President Trump signed an executive order directing Congress to find a solution to end surprise medical billing by December 31. So far, Congress hasn’t fixed the problem, but the lame-duck session set to begin shortly after Thanksgiving will offer lawmakers a chance to protect Americans from surprise medical bills.

As the President pointed out in his executive order, surprise billing is when “a patient receives unexpected bills at highly inflated prices from providers who are not part of the patient’s insurance network, even if the patient was treated at a hospital that was part of the patient’s network. Patients can receive these bills despite having no opportunity to select around an out-of-network provider in advance.”

Americans typically receive surprise bills related to unplanned or emergency treatment from out-of-network hospitals, physicians or ambulance providers. But surprise bills can also pop up when a patient receives planned care, such as an elective surgery, and later discovers that a provider such as an anesthesiologist or radiologist does not participate in his or her health insurance network.

Every year, millions of Americans find themselves on the hook for outrageously expensive surprise medical bills. The bills are a disastrous drain on Americans’ wallets. If specialist physicians like radiologists and anesthesiologists were not allowed to bill out-of-network, annual healthcare spending for people with employer-sponsored insurance would fall by 3.4 percent – or about $40 billion annually – according to a study published in Health Affairs.

Here in North Carolina, 11 percent of all emergency room visits result in at least one surprise bill. Patients and health insurance companies are forced to pick up the costly tab. The state’s largest insurer, Blue Cross Blue Shield of North Carolina, says surprise medical bills increase premiums for its customers by $14 million a year.

Fortunately, Congress has a golden opportunity to stand up for patients and put an end to expensive and unfair surprise medical bills. Banning surprise bills has bipartisan support in both the House and the Senate. Various proposals are currently alive in Congress, but lawmakers should focus on policies that meet three important criteria.

First, surprise medical billing should be banned in situations where patients are involuntarily treated by an out-of-network provider, such as emergency care.

Second, proposals that include arbitration schemes to resolve price disputes should be rejected. Researchers from the USC-Brookings Schaeffer Initiative for Health Policy found that health care costs are increasing in states that use arbitration to address surprise billing. Arbitrators typically base their price determinations off a percentage above the average cost for a procedure. As a result, arbitration incentivizes providers to artificially inflate the prices of all services in order to give arbitrators a more expensive baseline from which to formulate their decisions.

Finally, Congress should adopt legislation that establishes fairly negotiated, market-based payments for out-of-network services based on the going rate of in-network rates for the same service. This ensures providers are paid fairly while protecting patients from stifling costs.

This Congress only has a few weeks to pass legislation. Once the lame-duck session ends and new members are inaugurated, the process will start all over again.

President Trump has already indicated that he will sign any bill that lawmakers on Capitol Hill adopt to address surprise billing. In fact, it may be the final piece of legislation he ever signs into law. If that were the case, Trump would end his presidency on a high note by ratifying a popular bipartisan bill that would protect hundreds of millions of Americans from being taken advantage of when they’re at their most vulnerable.

Donald Bryson is president and CEO of the Civitas Institute, a nonprofit public policy organization based in Raleigh.