Squabbling over health care in Congress is routine. But there is one issue where there is bipartisan support: protecting consumers from surprise medical bills.
Central Oregon’s congressman, Rep. Greg Walden, R-Hood River, deserves credit for leading a bipartisan bill with one possible solution that would bring consumers relief.
It’s not hard to find a story of someone who received a surprise medical bill. There are some nightmarish tales. The plot is usually similar. Someone has a medical emergency, gets treatment and is surprised to learn the treatment is considered out-of-network and not covered or only partially covered by insurance. They get stuck with a big, unexpected medical bill. About 20% who are treated in an emergency room or admitted to a hospital end up being treated by a doctor who is not in network, according to some studies.
Walden has told the story of a mother, Sonji Wilkes, who testified before the Energy and Commerce Committee. Walden is the Republican leader of that committee. After her son was born, he had a medical issue. He was transferred to the neonatal intensive care unit 50 feet from where he was born. The hospital was in her network. But the hospital contracted out the intensive care unit and it was not. She ended up with a surprise bill for $50,000.
The debate in Congress has been how to fix problems like this. The consensus seems to be that patients should not be billed for things insurance will not cover. So then how are medical providers and insurers supposed to agree on the price? Three variations are typically mentioned.
Should a fixed out-of-network price be imposed in some way? Some people don’t like the idea of government price setting. In Walden’s bill, though, the benchmark payment for out-of-network surprise bills would be — at least — the median in-network rate for the service in that region.
Should an arbitrator be used to settle disagreements over a set price? That has been criticized, because it may drag out the process and gives a lot of power to the arbitrator. It is the approach in Walden’s bill — allowing parties to appeal a price. Should providers be compelled to sign contracts ahead of time — effectively guaranteeing that everything is in network? That is criticized because government would be forcing entities into contracts they may not want.
The Oregon Hospital Association wrote Walden earlier this year about his bill. One primary concern was that any rate setting done at a national level “would create disincentives for insurers and could not take into account all of the variabilities between individual markets to ensure adequate payment for large urban health system and independent critical access hospitals.”
We can’t say what approach is the right answer to best protect patients and also take into consideration the effects on providers and insurers. There may not be a perfect one. But Congress needs to implement a solution, and Walden should ensure the performance of that choice is tracked.