Putting patients first: Protecting Americans from surprise medical bills

Two-thirds of Americans cite unexpected and surprise medical costs as their top financial worry – a burden they have little to no control over thanks to a health care system that offers little transparency or assistance for those in need. As a result, patients recovering from an emergency are often buried by overwhelming, unexpected medical bills that become financially debilitating and threaten their long-term economic stability.

Nationally, one in six emergency room visits results in an unexpected medical bill and one in seven in-network admissions end with a surprise medical bill. Nearly 70 percent of patients fail to pay off those bill balances—and this number is expected to climb to 95 percent by 2020.

These are staggering numbers, and this is a crisis that demands our immediate attention and action.

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During my time serving in the New York State Assembly, I helped author and pass landmark legislation to address the practice of surprise billing statewide. Now, I’m proud to partner with my colleagues to establish a similar nationwide measure and ensure peace of mind for families everywhere.

Our legislation, the Protecting People from Surprise Medical Bills Act, allows insurance companies and doctors to negotiate surprise medical bills, taking the patient out of the middle. If they cannot reach an agreement, a neutral, independent arbiter can step in and decide which party has offered a reasonable amount. This discourages doctors from submitting outrageous charges and prevents health plans from low-balling providers. Most importantly: the patient is not stuck with the bill.

Since enactment, New York’s law has yielded $400 million in savings to consumers, a 34 percent decrease in out-of-network charges, and 9 percent decrease in in-network emergency room payments. It’s clear that the Independent Dispute Resolution model has proven to be both effective and equitable – and it is critical that any measure advanced by the House of Representatives to address the predatory practice of surprise billing nationwide must include this system of arbitration.

An alternate proposal, espoused by health insurance companies, calls for government price setting. This would enable insurance plans to dictate what doctors may charge for their services—or drop them from their networks if they step out of line. The result would endanger networks and access to care, especially in underserved communities and rural areas across the United States.

While I applaud the intent of my colleagues who have advanced alternate proposals to end surprise billing, I have serious concerns about the equity of benchmarking and price-fixing systems which would give tremendous power to insurers. Our top priority must be protecting patients—not padding the pockets of insurance companies.

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Independent Dispute Resolution prioritizes the needs of patients and allows for a balance of power between providers and insurers. This model is also fiscally responsible and can yield large savings. As the end of the year rapidly approaches, we cannot let the opportunity to take action and finally end surprise billing pass us by. I am hopeful that we can reach a compromise based on the framework of neutral and fair arbitration to provide much-needed relief and peace of mind to patients across America.

There is much work still to be done to repair our broken health care system – but this legislation marks an important step forward in our efforts to create a more affordable, transparent, patient-centered system of care that works for everyday Americans.

Morelle represents New York’s 25th District and is a member of the Education and Labor Committee.

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Written by Alan Smith

Alan Smith

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