Within the past two years, 4 in 10 Americans experienced the burden of surprise medical bills. These bills — often in the thousands — occur when insured patients are unexpectedly treated by an out-of-network provider. According to a recent poll by the Kaiser Family Foundation, people overwhelmingly want federal laws that protect them from these unfair bills.
Early this year, President Trump vowed to “stop all of it.” And last week, he laid out broad principles and called on Congress to pass legislation that ends surprise medical billing. Unfortunately, those principles fall short of outlining the protections consumers need. They seem more like an effort to create the appearance of being on the right side of the issue without the reality. Further, through those principles, the administration seeks to advance its own agenda that chips away at the foundation of the Affordable Care Act (ACA).
How do the administration’s principles to combat surprise medical bills miss the mark?
First, the Trump administration’s principles would leave people unprotected in many situations. Instead of explicitly prohibiting surprise medical bills in all situations where patients have no ability to ensure they receive care from in-network providers, the administration focuses just on emergency care setting. As described in our open letter to the president in January, surprise billing occurs in multiple settings. A carefully planned visit to an in-network facility or an emergency visit to a local hospital could result in services delivered by out-of-network physicians. An ambulance trip to a near-by hospital can result in thousands of dollars in medical bills. Even when patients do everything to make sure they receive care from in-network providers (and rely on an inaccurate provider directory), they could end up inadvertently receiving care from an out-of-network provider. We call on policymakers to put in place robust consumer protections, totally banning surprise medical bills. This means that patients should never receive a medical bill they incur through no fault of their own. Moreover, consumers should not bear the burden of resolving the payment dispute between insurers and providers.
Second, consumer protections against surprise medical bills could be “switched off” by inadequate notice requirements. The transparency the Trump administration is pushing is not a cure-all for what ails the health care system. Using transparency as a substitute for robust consumer protections against surprise medical bills will have little-to-no effect on consumers’ ability to shop for health care services and improve affordability. While there is broad consensus that patients should be informed when their care is out-of-network and understand their financial obligations, patients often have no ability to seek alternative in-network providers. Disclosure and transparency requirements should not be a substitute for consumer protections from surprise medical bills; they should be a complement.
Third, the Trump administration’s principles do not address the market power of providers that drive up costs. There is no evidence that price transparency reduces health care costs. Research shows that the growing problem of surprise medical bills is driven by a combination of narrow networks and excessive provider prices (a result of provider monopoly power). Consumers are becoming collateral damage in the struggle between health plans and providers. They are forced to pay twice — once through the out-of-network bills they cannot plan for and again through higher premiums. Thus, if the goal is to lower health care costs for patients, policymakers should develop policies that will put a check on the growing monopoly power of providers while protecting patients from high health care costs.
Finally, the administration’s policy agenda does not lower people’s health care costs. In fact, it makes health care less affordable. The Trump administration talks about their efforts to lower health care costs for consumers, but their actions tell a different story. For instance, by expanding the availability of short-term health plans and associate health plans, the administration creates a parallel market that will siphon off healthier consumers and lead to increasing premiums for those living with pre-existing conditions who rely on the ACA’s comprehensive coverage. Further, by urging the U.S. Court of Appeals for the Fifth Circuit to strike down the entire ACA, the administration puts millions of people across the country at risk of losing health insurance coverage. The133 million people living with pre-existing conditions like cancer, asthma or diabetes could be exposed to health insurance discrimination and medical debt.
If the Trump administration sincerely wants to protect American patients from surprise medical bills and lower health care costs, they would abandon their efforts to tear down the protections that currently exist under the ACA and support comprehensive protections against surprise medical bills. Though we are not holding our breath, we call on the administration to first do no harm and work with Congress on policies that actually improve affordability, control overall health care costs and promote health justice for all.