Opinion

Time to Abolish the Surprise Medical Bill Loophole

By Isaiah Cochran
January 24, 2020 at 5:00 am ET

After years of trying to rein in excess profits in health care, the United States is finally on the cusp of providing nationwide relief to people struggling with high-cost surprise medical bills.

Patients can get stuck with outrageous bills when they get emergency care from an out-of-network hospital or when they visit an in-network hospital but are seen by an out-of-network doctor. The next thing they know, they are being hounded aggressively to pay tens of thousands of dollars, even though they are insured. Most often, they are paying far more than what they would pay for comparable treatment in network.

No one is immune to this threat. It can happen to anyone, regardless of his or her insurance plan. Surprise medical bills can quite literally ruin people’s lives, forcing them to empty their savings or go deep into debt.

Many members of Congress have highlighted this issue and promoted the importance of passing a law to keep this from ever happening to another family. Until recently, surprise medical billing legislation appeared to be one of the few things that could actually get bipartisan support in Congress.

But behind-the-scenes squabbling by special interest groups and a new influx of “dark money” from medical staffing companies that are reaping massive profits are now stifling high hopes for legislative relief. Despite near-universal agreement that surprise medical bills are wrong and that we need legislation to end this practice, a current bill to address the issue is now stalled thanks to relentless lobbying from special interests seeking to protect their profits.

The problem isn’t that doctors and insurers don’t agree on a common path forward. Now, private-equity firms are lobbying against this bipartisan bill, hoping to stop any decrease in their profits — even if it means gouging patients for services that they didn’t know they were receiving from out-of-network physicians as part of their emergency room visit at in-network hospitals.

The well-being of patients is getting lost in the shuffle as some doctors’ groups such as the American Medical Association argue for a third-party arbitration process to determine a fair price for medical services, based on proposals from insurers and doctors. Big insurance companies are lobbying for a method called “benchmarking,” where out-of-network bills are linked to in-network rates. Benchmarking could mean a big pay cut for doctors and less money for hospitals. Doctors are worried this method would also give the insurers too much power to decide which doctors they choose to include in their networks.

And now, dark-money groups with private-equity investments in medical staffing companies are spending millions of dollars on ads opposing the benchmarking approach, too. They are targeting legislators with fear-mongering messages, saying the benchmarking approach could end up driving hospitals out of business and leaving patients without doctors to treat them.

As physicians-in-training, we’re concerned that the aggressive lobbying and dark money pouring in from hedge-fund-backed medical staffing companies profiting from surprise bills might just make this issue too hot to handle and take the wind out of the sails on this important legislation, leaving patients to pay the price. At the American Medical Student Association, we believe the way forward should be guided by what is best for patients. As future doctors, we can imagine a world where health care treatment is more accessible, medicine is affordable and health care systems support the diversity we see in the world around us.

Many of us have experienced surprise medical bills ourselves, and even more have heard inevitable horror stories from our patients, friends, family and neighbors. In 2017, a study by the Kaiser Family Foundation found that “1 in 6 Americans with insurance were surprised by a medical bill after treatment at a hospital.” And, recently Sen. Bernie Sanders (I-Vt.) received 50,000 responses to a viral campaign tweet, asking “What’s the most absurd medical bill you’ve ever received?” Even President Donald Trump has said that combating the problem of surprise bills is a priority.

Over the years, AMSA has worked hard to protect Medicaid, Medicare and the Children’s Health Insurance Program, expand access to health insurance and improve coverage through the Affordable Care Act, but we know there’s still more to do. Patients deserve to receive the treatment they need regardless of whether they’re in the “right” hospital or seeing the “right” doctor without worrying they might lose their home or go into significant debt as a result.

All doctors take an oath to do no harm, and most medical students choose this profession because they want to help people. However, these surprise bills mean that even when a doctor helps someone, that patient might end up suffering even more when faced with the unexpectedly high cost of treatment.

This Congress is uniquely positioned to address the issue of surprise medical bills and help millions of Americans. As future physicians who will be caring for patients in congressional districts across the country, we call on Congress to fix this problem now.

We cannot let special interests once again derail commonsense legislation. It’s time to abolish this surprise medical bill loophole that continues to drive up costs and hurt our patients.

 

Dr. Isaiah Cochran is the national president of the American Medical Student Association.

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