WHY IT MATTERS

Why Federal Legislation to End Surprise Medical Bills is So Important

After several reports of sky high medical bills, more than two-thirds of Americans are worried about receiving a surprise medical bill, causing them to take extreme measures to delay and avoid medical care. Americans deserve better. 

 

Congress must act to protect patients from billing disputes between insurance companies and doctors. Several politicians have introduced legislation to end surprise medical bills, but they are not all equal. Some politicians want the government to set rates at the median in-network rate, others want to use a market-based solution, an independent dispute resolution (IDR) process. 

 

If the government sets rates at the median in-network, insurance companies will have even more control over your healthcare. Here's how:

  1. Hospital Closures. Researchers have found 15% of U.S. hospitals have closed since 1990 and the rate of hospital closures have increased in the last decade — this is linked to inadequate reimbursement for physicians that are legally and morally bound to provide care to all patients regardless of their ability to pay. Allowing insurance companies to reduce rates further will shutter safety-net hospitals that are already operating at thin or negative margins.
     

  2. Doctor Shortages. The Association of American Medical Colleges projects a physician shortfall of 46,900 to 121,900 physicians by 2032. Rate-setting will worsen these projected “supply shortages” and “[undermine] the benefit of protecting patients from balance billing.”
     

  3. Due to Manipulation. Since there is not a transparent and independent database of rates, insurance companies will be able to manipulate the median in-network rate by canceling long-standing in-network contracts, as they have in California, which passed a similar rate-setting measure in 2017.
     

  4. Unsustainable Financials. Utilizing median in-network rates will result in lower physician reimbursements, which can further exacerbate doctor shortages and hospital closures. The Congressional Budget Office (CBO) projects a 20% reduction in physician reimbursement nationwide, some areas will face even more drastic rate reductions.
     

  5. Communities will Suffer. When hospitals close, entire communities suffer. Jobs are lost, neighboring medical facilities are strained, and mortality increases.

Ending surprise medical bills shouldn’t jeopardize Americans access to care, and it doesn’t have to. 

 

There is another way, and it is called an independent dispute resolution process (IDR). IDR will allow physicians and hospitals the chance to fight for the reimbursements they need to keep their doors open. Instead of insurance companies dictating the cost, an independent arbiter will decide what is fair.

  IDR IS A PROVEN SOLUTION  

In 2014, New York was the first state to implement an independent dispute resolution process. Since then, ​

  • Premiums have grown slower than the rest of the country

  • Provider charges have seen minimal change

Contact your member of Congress and tell them to: