Recently, Stanford University released a stunning report on surprise medical bills. Nearly half of insured emergency room patients at in-network hospitals received an out-of-network bill. But if patients had health insurance and were at in-network hospitals, why were they—and not their insurers—sent expensive medical bills?
The answer may give you vertigo. While the hospital was within the patient’s insurance network, the doctor who works for the hospital was not, which resulted in the patient receiving a surprise bill. According to Kaiser Health News, one in six patients don’t know that they are being treated by an out-of-network doctor. In fact, many of them reasonably assume that because the hospital is in-network, its doctors must be as well.
But setting all that aside, patients can’t ask for an in-network doctor when facing a medical emergency. And, even if some could, it would be dangerous for them to wait for an in network doctor to treat them. These are obvious risks—and insurers must know this, but surprise bills allow them to dodge having to cover the medical expenses of these vulnerable patients.
The good news is that Congress is on the verge of ending surprise medical bills. The STOP Surprise Medical Bills Act, introduced by physician turned Senator Bill Cassidy, would practically end the confusing in and out-of-network rules. In virtually every scenario, Americans would be treated as in-network patients, shielding them from out-of-network surprise bills. If Sen. Cassidy’s bill had been implemented earlier, patients wouldn’t have faced surprise medical bills. Instead, insurers would have been held responsible for covering their customers’ medical bills.
There’s only one thing stopping this bill from passing: insurance lobbying groups. These dark-money organizations have been pressuring lawmakers to protect the healthcare industry’s lucrative scheme.
Caving to their pressure, Congress has announced a so-called “deal” on surprise medical bills between the House and the Senate. This agreement would scrap the patient protections in Sen. Cassidy’s bill and instead empower the government to set fixed medical prices. The latest deal, in other words, would not end surprise medical bills—and, worse, it would open the door to Medicare for All. In addition, the “deal” would allow insurance companies to push for low government reimbursement rates, so that these private equity-backed organizations can further increase their profits at the expense of patients.
It’s clear that the consequences of this proposed deal would be devastating. Throughout recent history, government rate setting has led to doctor and hospital shortages, hurting, in particular, rural areas that already have little access to medical care. And should this legislation pass, it would allow insurance companies, in conjunction with government bureaucrats, to set exceptionally low rates that would make it difficult for rural hospitals to survive financially.
I am confident that my state’s representatives, which includes Senator Thom Tillis and Representative George Holding, who both represent rural communities, will, unlike some Democrats, side with ordinary patients over powerful insurance lobbyists. Knowing their strong records of protecting and defending patients, it is my hope that they will reject this deal that only benefits the profit margins of insurers.
Katlyn Batts is the Chairwoman of the Wingate University College Republicans and an employee of the Jesse Helms Center.