Negotiations to end surprise billing have been at an impasse for nearly a year. Discussions between the White House and congressional leaders over another coronavirus bill offer an opportunity to finally end this practice that defrauds millions of patients every year.
The lobbying battle lines are well defined. On one side stand the private equity firms that have bought medical staffing agencies and medical specialty practices and who favor binding arbitration. Opposing them are lobbyists for insurers and employers who want government to set payment rates for out-of-network care.
Each side wants Congress to impose the costs of protecting patients on the other. To break the impasse, the Trump administration is reportedly proposing a ban on balance billing for any medical services provided at an in-network hospital, a point on which both sides agree. It relies on the parties involved—insurers, doctors and hospitals—to sort out appropriate payment amounts without government involvement.
Congress should end the battles over this issue and prevent patients at in-network hospitals from being billed any more than the network cost-sharing amounts stipulated in their insurance contracts.
Most specialists don’t ambush patients with surprise bills. Many hospitals don’t permit it. We have proof that private sector negotiation can solve this problem.
The medical specialists who exploit patients with surprise bills are in the minority, but they do great damage. Congress should protect patients against this fraudulent practice by banning balance billing and leave the rate-setting to the private sector.
A not-for-profit health and tax policy research organization.
