Surprise medical bills have become a top health concern for patients in the U.S. Our recent report discussed two key factors contributing to this growing problem — the spread of narrow network plans and excessive provider prices linked to provider monopoly power. Patients are becoming collateral damage in the struggle between health plans and providers. They are forced to pay twice — through the out-of-network bills they cannot plan for and through higher premiums. At Community Catalyst, we believe it is important to devise policies that will put a check on the growing monopoly power of providers while also protecting consumers. Ending surprise medical bills, if done correctly, has the potential to do both.
It is encouraging to see federal lawmakers from both parties pursue legislation to address this problem. Over the past three months congressional committees have convened meetings, collected input from stakeholders and introduced several bills – the STOP Surprise Medical Bills Act of 2019, the Lower Health Care Costs Act, the Protecting People From Surprise Medical Bills Act, and the Reauthorizing and Extending America’s Community Health Act. In general, there is a bipartisan agreement that robust protections are needed to hold patients harmless from exorbitant medical bills. We have summarized each of these bills in a new issue brief.
As consumer advocates, consumer protections are our number one priority. Robust consumer protection means that patients are held harmless and not caught between insurer and provider disputes. We are pleased that many of our concerns are addressed— some better than others —in the federal bills currently being worked on.
However, how to resolve out-of-network payment disputes between insurers and providers is and continues to be a sticking point for enacting protections. To successfully protect insured patients, it is critical to address how out-of-network payment disputes between insurer and provider will be resolved. A number of approaches have been proposed, including arbitration (or independent dispute resolution) and benchmark setting at median contracted rate. We have broken down Congress’s approaches to each of these in the brief. In general we believe that it is important to resolve the payment question in a way that prevents either providers or insurers from taking advantage of monopoly power.
People across the country have voiced their concerns and called on their elected officials to work together to lower health care costs and protect them from financial ruin. We applaud the serious efforts in Congress to address this problem. But the job won’t be finished until there is legislation that provides both comprehensive consumer protections and reduces excessive health care costs.