Column | Congress must cure the problem of surprise medical billing
Debbie Moehnke’s heart attack took her by surprise. It happened in March 2018, while she and her husband were waiting for treatment at a Vancouver, Washington-area medical clinic. The medicos there sprang into action, starting the process that saved the life of the 59-year-old woman.
First, they sent her to the local hospital where her condition stabilized. Then the hospital transferred her to the Oregon Health and Science University just across the river in Portland where she received the critical cardiac care she so desperately needed. According to The Oregonian newspaper, “That meant heart bypass surgery, replacement of one valve and repair of another.” Because of a post-operative infection erupting in her leg, she needed treatment with powerful antibiotics administered intravenously.
Moehnke spent nearly a month in the hospital, including a stay in intensive care. She survived because America has the best care anywhere. And because she played by the rules, because she had insurance, she expected everything was going to be okay.
Then came the second surprise hit, a medical bill totaling more than $454,000 of which her insurance would only pay half. The OHSU facility where her life had been saved was “out of network,” meaning she was personally responsible for nearly a quarter of a million dollars in medical bills.
These kinds of surprise medical bills are becoming commonplace. According to a survey by the University of Chicago’s National Opinion Research Center, more than half of American adults have gotten at least one at some point in their lives. These are not scofflaws, seeking to live outside the healthcare system by failing to buy insurance and shifting the costs of their care to others. These are everyday folks playing inside what they thought the rules are, only to find themselves sadly surprised by the unexpected.
For the Moehnkes, the bill was potentially ruinous. “I wish I would have known,” she said in interviews. “I would have said ‘No’ to life support” and that the situation left her and her husband fearing they’ll “lose everything.”
Fortunately for them, their appeal of the bill to Washington State Insurance Commissioner Mike Kreidler was upheld and the debt was eliminated. But for thousands of other Americans, perhaps more, the problem of surprise medical billing is a ticket time bomb waiting to go off.
A June 2019 poll of 1,500 registered voters by Morning Consult found that 81 percent of Americans believe health insurance companies are to blame for surprise medical billing. They’re probably right. They helped write Obamacare into law and now are working to keep the government bending their cost curves down through the imposition of price controls on doctors and hospitals.
The Lower Health Care Costs Act, which the insurance industry is pushing, would strengthen its power in Washington. It would hamper medical innovation – insurance companies are reluctant to pay for new treatments, new procedures, and experimental drugs until they’re proven – and create shortages in providers at a time when the system in so much of the country is taxed to the limit.
A key feature of the Lower Health Care Costs Act, capping medical coverage to “median in-network” rates, would be an unmitigated disaster. The health insurance cartel can do things to drive the median rate down, year over year, to a point so low doctors quit the business, hospitals close and patients lose both choice and access.
That’s not real relief, which is what the American people deserve. The bipartisan STOP Surprise Medical Bills Act is the commonsense solution to this unnecessarily complex problem. Developed by Louisiana Republican Sen. Bill Cassidy and New Hampshire Democrat Maggie Hassan, it would allow arbiters to take testimony from all parties involved and dictate a reasonable compromise.
The Cassidy/Hassan approach restricts the power of the insurance lobby, protects patients like Debbie Moehnke, and shields doctors and hospitals from price-fixing controls. Not only do nearly 70 percent of American prefer this route but medical professionals resoundingly voice approval for it.
“The American College of Emergency Physicians stands with the majority of Americans in favor of independent dispute resolution, which takes patients out of the middle and establishes a fair, efficient process to resolve differences between insurers and providers,” ACEP President Vidor Friedman said in June.
Congress must act now on surprise medical billing to protect the most vulnerable patients across the nation from financial hardship, but lawmakers must not cave to Big Insurance. Ultimately, legislators should push for a solution that protects patients, strengthens doctors and hospitals, and upholds health care markets.