Solving surprise medical billing with the STOP Surprise Medical Bills Act

OPINION:

This has been a year of uncertainty for Americans from every state and from all walks of life. With a pandemic continuing to threaten our communities and businesses across the nation shutting their doors, people simply do not know what tomorrow may hold, or if they will be in a position to support their families. Making matters worse throughout all of this is the continuing danger surprise medical bills pose to America’s patients.

Surprise medical bills are a persistent problem that can arise when someone unknowingly goes to see a doctor that is not a part of their coverage network. Assuming that their insurance company will cover the expenses, they only discover after the fact that they are stuck with the bill themselves. These charges also often leave medical providers in a difficult situation, as they struggle to receive fair compensation from insurance companies for their services. 

Recognizing the importance of solving this issue, President Trump has tasked Congress with finally drawing up a legislative solution and providing relief for patients. However, some proposed solutions are better than others, and lawmakers should step carefully as they craft a bill to present to the president.

One method, which has been brought forth by Sens. Patty Murray, Washington Democrat, and Lamar Alexander, Tennessee Republican, is for the government to set rates. However, this is a proposal rife with pitfalls that will doubtlessly make things worse for patients and medical providers alike.

If the government was left to set rates, big insurance companies would quickly deploy their already extensive lobbying efforts to protect their profits and lower the reimbursement rates on which doctors and frontline providers depend. Instead of prioritizing the wellbeing of patients — as smart health policy should — rate-setting would give precedence to high-powered insurance companies.

Making matters worse is that struggling rural hospitals and small practices would continue to suffer under a government rate-setting system. As insurance companies push for rates that best suit their profit margins, artificially-deflated rates will force rural providers and small, private practices to shut down as they are left unable to sustain their business. With all this room for error, Congress should instead turn its attention toward another proposal that has already proven successful for several states.

Sen. Bill Cassidy, Louisiana Republican, has proposed a fix that will benefit both patients and medical providers. The STOP Surprise Medical Bills Act would implement an arbitration system that provides a way for doctors to come to fair agreements with insurers on compensation, without putting any unwarranted burden on the patient. With an arbitration method, the parties instead use an independent third-party mediator to settle any disputes that arise, providing medical providers with a platform to ensure they are fairly compensated for their work.

Several states have already put an arbitration system into place, with great success. Florida, Texas, New York and Maine each have implemented such a system, helping to ease the problem of surprise medical billing for patients. Mr. Cassidy was smart to recognize the benefits their approach has yielded, and now his colleagues in Washington would be wise to support his proposal and put it on the president’s desk.

Now more than ever, we cannot afford to continue sticking patients with surprise medical bills. Mr. Trump has already taken great steps to solve surprise medical billing by tasking Congress to present him with a bill focused on providing patients and medical providers with the safeguards they need. Now, it is up to conservative leaders in Congress, working closely with Senate Majority Leader Mitch McConnell, to help get Mr. Cassidy’s STOP Surprise Medical Bills Act over the finish line.

When patients fall ill, their focus should be on recovery, not worrying about how they are going to afford their treatments. We are in the midst of a global pandemic and Americans everywhere are experiencing unprecedented hardships. Failing to address surprise medical billing will only ensure that things get worse before they get better, and that Americans will continue to face uncertainty when they seek medical care.

• Matt Mackowiak is president of Potomac Strategy Group, LLC. He’s a Republican consultant, a Bush administration and Bush-Cheney re-election campaign veteran and former press secretary to two U.S. senators.