Surprise billing solo sounds more like a government healthcare duet

Ross Marchand

June 25, 2019

This article was originally published in the Washington Examiner on June 20, 2019. 

In the cacophony of Congress’ “greatest” healthcare hits, the issue of “surprise billing” has been topping the charts for weeks now. The partisan divide on healthcare hardly seems relevant anymore, as Republican-led proposals to set physician pay and micromanage the medical system are increasingly echoing the single-payer chorus of the presidential hopefuls on the crowded Democratic campaign trail. The same sorts of failed ideas trumpeted in Sen. Bernie Sanders’ campaign literature were presented unironically by Republicans during the House Energy and Commerce Committee hearing last week, as well as by an encore of witnesses advocating for fatally flawed surprise billing legislation as the Senate’s health committee considered an array of proposals this week.

With surprise billing being the inevitable result of Obamacare narrowing insurance networks, doubling down on big government solutions will do nothing to address the underlying causes of this pressing issue. Further federal intervention will only cause patients and taxpayers further suffering.

Just as the House Ways and Means Committee gaveled in their hearing on “Medicare for all,” the House Energy and Commerce Committee held a hearing on discussion draft legislation aimed at addressing unanticipated out-of-network care and the accompanying expenses to patients — often called surprise billing. For example, a situation could arise where a patient goes to an in-network hospital for an emergency surgery only to find that an attending physician was out-of-network and bills the patient separately. The lawmakers’ proposed bill would set strict caps on out-of-network bills, and in the case of a dispute, have insurers pay out-of-network physicians rates based on averages paid within their network.

Lawmakers don’t need to go too far back in history to see that government intervention in Obamacare, and the price-fixing and mandates that came with it, set the stage for surprise billing in the first place.

The year was 2010. Healthcare costs had been rising for decades, and politicians in Washington passed Obamacare promising to give people the security of knowing that insurance companies wouldn’t be able to bill them into bankruptcy because of an illness or injury. Obamacare attempted to curb growing healthcare costs by giving the government the power to set the rates with “community rating” price controls and mandated that people participate in specific health insurance networks that met strict federal regulations or suffer a financial penalty.

Nine years later, the government price controls and billions in taxpayer-funded subsidies have done little to lower healthcare costs. Instead, the narrow networks that Obamacare put into place have created quandaries for patients trying to find in-network hospitals with in-network physicians. Instead of fixing this problem, lawmakers are proposing to double down on the very same price fixing and onerous rules that created it in the first place.

The No Surprises Act, co-authored by House Energy and Commerce Committee Chairman Frank Pallone, D-N.J., and ranking member Greg Walden, R-Ore., builds on previous, failed forays into the healthcare sector, inviting the government to shackle restrictive pricing policies onto physicians and hospitals as seen in the proposals taken up by the Senate this week. 

Sens. Lamar Alexander, R.-Tenn, and Patty Murray, D-Wash., have a proposal that goes a step further and includes an “in-network guarantee,” also referred to as “networking matching” that would require that any hospital considered “in-network” for a health plan must promise that everyone working there is also in-network. Under the “network matching” approach in the proposed legislation, doctors are essentially banned from supporting hospitals without first joining their insurance network. “Network matching” would stymie doctor recruitment in rural areas, where the promise of high pay and independence is the largest draw for medical students contemplating a thousand-mile relocation. As a result, this insurance mandate would be devastating to communities where a scarcity of physicians, smaller patient populations, high rates of uninsured patients, and dwindling cash flows have all contributed to rural hospital closures. 

Government-set rates and network participation mandates will do little to solve the underlying network problem behind surprise billing, while fast-tracking America toward a costly, disastrous “Medicare for all” system. Instead of flawed mandates, the government should reduce regulation of the healthcare sector and allow medical facilities to more freely compete with one another in order to drive down prices. As lawmakers race to reach a compromise before the August recess, patients and taxpayers across the country should embrace the sweet sound of streamlining rules and balk at the tone-deaf single-payer duet.

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