Beware of Congressional 2020 Wish List

One of the items on the congressional list of unfinished business of 2019 was legislation to address “surprise medical billing.” As health care costs have risen higher and higher, some Americans have seen huge bills handed to them unexpectedly as they finish health treatments.

There are ways to address this problem, but the solutions that have been favored by Congress amount to little more than a massive government expansion into care decisions that should be left between a patient and a doctor — with taxpayers footing the bill.  

The current showdown is between a benchmark proposal, included in the Senate’s “Lower Health Care Costs Act” (S. 1895) and the House’s “No Surprises Act” (H.R. 3630), and an arbitration proposal featured in S. 1531 and H.R. 3502. “Benchmarking” would set a fixed payment rate for out-of-network doctors who provide care to a patient in an emergency situation. Arbitration would involve doctors and insurers submitting bids for how much a doctor should be reimbursed for services to a third party, with the third party deciding on an amount from there.

Unfortunately, neither proposal is ideal for empowering markets to provide the best outcomes for patients and taxpayers. Benchmarking, in particular, introduces government rate-setting to private contracts between doctors, hospitals and insurance companies. This proposal, if enacted into law, will put undue pressure on doctors and impact the delivery of care at hospitals and emergency rooms.

Negotiated rulemaking is an even larger concern looming in Congress. The chairman of the House Ways and Means Committee is considering establishing a negotiated rulemaking committee. This would include bureaucrats from several important federal agencies including the departments of Health and Human Services, Labor and Treasury — along with “key stakeholders.”

In response, a coalition of 15 pro-market and pro-taxpayer groups sent a letter to the chairman, ranking member and other members of the House Ways and Means Committee with a list of concerns — chief among them that negotiated rulemaking would lead to a forfeiture of congressional authority to the bureaucracy. Taxpayers deserve solutions from their elected officials, not from unelected executive agencies.

A better approach is to open up the marketplace so that consumers have more information about the availability, cost and quality of health care professionals in their area. A patient-centered system will treat Americans like human beings, not merely statistics to be negotiated over by bureaucrats in Washington.

Remember the rollout of the Obamacare website? Do we really want these people making more of our health care decisions?

Despite legitimate concerns raised by taxpayer and patient groups, it is still possible that the members of Congress might force together a number of these bad ideas in an arcane process that will be shielded from public debate.

Don’t forget that Obamacare was first introduced in the House as part of the “Service Members Home Ownership Tax Act of 2009.” It then went to the Ways and Means Committee. The “Patient Protection and Affordable Care Act” was passed by the Senate on a party-line vote.

If they could approve one of the largest changes to the health care system in the history of our country by stuffing it into what was initially labeled a completely unrelated home-ownership bill, who knows what other changes they might make over the next month. Patients and taxpayers need to be diligently monitoring what Congress may get up to in the new year, lest they wake up to a New Year’s resolution that harms all Americans.


Scott Walker was the 45th governor of Wisconsin, and he is a senior adviser to the National Taxpayers Union.

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