Congress must address surprise medical billing in the right way

By Rep. MaryAnne Kinney | Jul 09, 2020
Rep. MaryAnne Kinney

I, like many Americans, pay health insurance premiums every month with the expectation that our insurance company will provide coverage in a medical emergency. What surprises me was a recent study that found more than 50% of U.S. adults have a received a medical bill they assumed would be covered by their health insurance. These type of surprise medical bills are wrong, and Congress must take action.

Patients receive surprise bills through no fault of their own when insurance companies refuse to cover the full cost of a medical procedure or when insurers increase co-pays and deductibles. Although Congress is debating several bills to end the practice of surprise billing, some proposals would do more damage without actually solving the problem.

This bipartisan bill presented Sen. Lamar Alexander, R-Tenn., and Rep. Frank Pallone, D-N.J., appears tilted in favor of insurance companies and imposes a significant 20% pay cut on frontline medical professionals. This rate-setting legislation would lead to hospital closures and make it harder for patients to receive care, especially in light of the recent pandemic.

Now is not the time to give more power to insurance companies. Large health insurers are the most profitable entities in the health care system and have continued to post record earnings during the coronavirus pandemic. UnitedHealthcare posted profits of $3.4 billion last quarter, even as it continues to cancel contracts with doctors.

Insurers are increasingly using this market power to lower the reimbursements that doctors, nurses and hospitals depend on, kicking providers out-of-network if they don’t accept; this is not helpful to our rural hospitals in attracting doctors we desperately need.

Doctors and frontline medical providers from across the country, including groups like the American Medical Association, American Hospital Association, and the Federation of American Hospitals, oppose rate-setting because it fails to address the root causes of surprise billing and gives insurers the power to set prices.

More than 160 economists have also opposed rate-setting in any form, noting that “such proposals represent a direct government intervention in health care that would hurt access to care, especially for patients in rural areas.”

In the Maine Legislature, we addressed this issue. We sought the option to place an independent resolution specialist in the mix to look out for the patient's interest.

Fortunately, Congress is also considering another solution to end surprise billing that would protect patients and providers without giving insurance companies even more power. Sen. Bill Cassidy’s, R-La., STOP Surprise Medical Bills Act takes patients out of the middle by establishing an independent dispute resolution process for providers and insurance companies to mediate payment disputes.

Sen. Cassidy’s legislation has more than 30 bipartisan cosponsors in the Senate because IDR has worked at the state level in both New York and Texas. Academic studies have shown that the New York law is already proving effective because it brings both parties to the table to reach a fair resolution and removes patients entirely from the process.

Earlier this month, the Trump administration also released a plan they believe will end surprise medical billing. Although it is promising that the White House has joined the debate, their proposal is a step in the wrong direction because it guarantees that insurance companies maintain negotiating power over providers and doesn’t actually solve the problem of surprise billing.

The proposal will lead to more lawsuits between insurance companies and providers because it doesn’t create any mechanism to resolve disputes. As a result, insurers will pass more costs onto patients in the form of higher co-pays and premiums to cover the cost of litigation. The American Medical Association has come out against the proposal because it gives health insurers too much power over doctors, nurses and other providers fighting on the front lines of this pandemic.

I respectfully urge Sen. Collins and the rest of Maine’s Congressional delegation to rally behind Sen. Cassidy’s plan to end surprise billing. IDR has a proven track record at the state level and is supported by doctors and patients. It is a better solution for rural area like we have in Maine.

Rep. Mary Anne Kinney, R-Knox, represents District 99 (Brooks, Burnham, Freedom, Jackson, Knox, Monroe, Thorndike, Troy and Unity) in the Maine House.




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Comments (2)
Posted by: John E Marshall | Jul 10, 2020 13:37

Three words: Capitated Manage Care which requires hospitals, doctors and other providers to have "skin in the game".

Fee-for-Service reimbursement is the problem because  providers get paid regardless of the efficacy of the treatment or the outcome.

Posted by: Paul Sheridan | Jul 09, 2020 09:56

Two words: Universal Medicare!

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