Patients Lose if Congress Tries Relief Bill Trickery
As Congress and the Administration continue to slog through negotiations toward the next COVID-19 relief bill, there are a host of pressing issues to tackle. Major concerns, ranging from unemployment benefits and economic recovery to health care aid and schools reopening, abound. There is one item quietly being debated, however, that must be tabled: a terrible “fix” to surprise medical bills.
Lawmakers who are trying to ram a “solution” to these surprise bills – which patients receive when their health insurer refuses to pay their medical provider – should rethink their position. The drivers of their supposed fix, such as benchmarking and price controls or an unfair independent dispute resolution (IDR) process that focuses on in-network median payment rates, would be disastrous for patients. Despite what some Members claim, we won’t be tricked into thinking these are real solutions.
At a time when close to 160,000 patients have succumbed to the coronavirus, Congress needs to expand access to care, address rising health care costs, and, frankly, protect their constituents’ lives. If lawmakers tuck the wrong approach to surprise medical bills into their upcoming relief package, they would be doing the exact opposite. No patient would ever be well served by an approach that uses benchmarking or unfair IDR. But given the current pandemic, patients of color will be particularly devastated if that were to happen.
According to reporting last month, “In San Jose Hills [Los Angeles County], where Latinos account for roughly 85 percent of the population, the number of cases per 100,000 was 143 times greater than it was during the second week of April.” Additionally, as Mario Lopez, president of the Hispanic Leadership Fund, noted in a recent column, “The Harvard Center for Population and Development Studies reports that Latinos ages 35 to 44 have a COVID-19 mortality rate nearly eight times higher than Caucasians in that age group.” The data is both staggering and painful to read.
Black patients are also suffering disproportionately from COVID-19. In a poignantly titled article from The Pew Charitable Trusts, “Covid-19 is Crushing Black Communities”, Christine Vestal and Michael Ollove’s analysis found that, “In the 16 states where Black residents’ share of the population is higher than the national percentage, the prevalence of death among Black residents exceeded their population share by as much as 25 percentage points.” As such, when talking about the Black community and surprise medical bills, the Rev. Al Sharpton is exactly right. He remarked in a speech in South Carolina that surprise medical bill legislation using benchmarking “needs to be defeated and replaced with something that would protect the underinsured and those with no insurance at all.” I could not agree more.
When our most vulnerable patient populations are already bearing the brunt of this crisis, it is inconceivable that Congress would want to add to their suffering. Yet implementing surprise medical bill legislation right now would only restrict their access to care.
But it’s not just patients who would be debilitated by an awful fix to surprise bills – so would our nation’s physicians. By using benchmarking or an unfair IDR process, Congress would set artificially low payment rates for them. This type of price control nationally would have severe consequences. Speaker Pelosi should know better, as she has already witnessed what a terrible price control law has done to her home state of California. The California Medical Association offers a stark warning: “Under California’s surprise billing law (AB 72, 2017), insurance company physician networks are diminishing, patient access to in-network physicians is declining, patient access to emergency physicians and on-call physician specialists is in jeopardy, patient deductibles for out-of-network care are increasing, and patient complaints about access to care have increased by almost 50%.”
Price controls – or benchmarking masquerading as an IDR process – would also add to the extreme financial hardship physicians are enduring due to the pandemic and resulting shutdowns. A new study from NDP Analytics shows just how badly independent physician practices are hurting. The study finds that, from March through June, these practices suffered an estimated $61.6 billion in lost revenue. Even worse, it estimates that their cumulative revenue loss from March until July of next year will be $158.3 billion. It is hard to fathom why Congress would want to further punish physicians when they are on their last leg.
As one might easily conclude, the only party that stands to benefit from these ruinous benchmarking or unfair IDR approaches is the colossal health insurance industry. Health insurers are recording their largest profits in history during this pandemic. As if that was not enough, they also have the audacity to suggest that they might raise premiums by as much as 40 percent in 2021. All the while, physicians are going out of business. The last thing Congress should be doing is giving a big gift to health insurers.
With such major implications for patients and physicians, surprise medical bills need to be addressed by Congress after our health care system recovers. Tying the issue to COVID-19 relief is just a trick. There are so many actual priorities to address in this next relief package. A terrible fix to surprise medical bills is not one of them.
Christopher Sheeron is President of Action for Health
