March 18, 2020

Dear Senate Majority Leader McConnell, Minority Leader Schumer, House Speaker Pelosi, and Minority Leader McCarthy:

As you debate and consider a legislative response for those affected by COVID-19, the undersigned groups representing millions of taxpayers and consumers urge you to reject any attempt to include any language that would seek to address surprise medical billing by creating a government-mandated benchmark (i.e. rate-setting) to determine out-of-network rates for physicians. Government price controls for medical bills would be particularly devastating at a time of great stress for our nation’s patients and healthcare providers.

Doctors and hospitals are on the front line of treating and fighting this disease. Mandating in-network rates would result in direct government price controls that would artificially suppress rates for providers offering out-of-network care, resulting in enormous financial losses that would be shifted to local hospitals and emergency rooms. 

Many of these facilities — particularly the ones serving rural, hard-to-reach communities across the nation — are already operating under razor-thin profit margins, if they are even profitable at all. Further compounding their financial woes could exacerbate a growing doctor shortage and lead to an increase in rural provider consolidation or even closure. The net result of any of these outcomes would be fewer options and higher costs for already at-risk patients. 

Lawmakers in California enacted a flawed approach called “benchmarking” in 2017 and patients across the state are suffering from the consequences. Benchmarking at the federal level would give the government authority to set arbitrarily low rates for physicians providing out-of-network care by tying payments to insurers’ deeply discounted in-network averages. This harmful rate-setting approach is included in legislation advanced by the Senate Health, Education, Labor & Pensions Committee, the House Energy & Commerce Committee, and the House Education & Labor Committee.

It is critical that at a time of a national emergency you focus on the needs of the country and not use the pandemic as an opportunity to enact government rate-setting that would harm our patients and our healthcare system.

Sincerely,