It’s Time to Block Surprise Medical Billing

by Peter Roff: Debbie Moehnke’s heart attack took her by surprise. While she was waiting for treatment at a Vancouver, Washington-area medical clinic back in March 2018. Not that these things are ever really expected.

The 59-year-old woman’s life was saved, first by sending her to a local hospital to get her condition stabilized. Then by transferring to the Oregon Health and Science University in nearby Portland for critical, life-saving cardiac care. According to The Oregonian newspaper, she received “heart bypass surgery, replacement of one valve and repair of another” and treatment with powerful antibiotics administered intravenously after a postoperative infection occurred.

Moehnke spent nearly a month in the hospital. She survived and, because she played by the rules, she expected her insurance would pick up most of the cost and everything would be okay.

That’s when the second surprise hit, one that was almost as devastating as the heart attack that almost took her life. She received a bill for more than $454,000 but, because the OHSU facility was “out of network,” her insurance would only pay half. She was now personally responsible for nearly a quarter of a million dollars in medical bills.

This is becoming a commonplace occurrence in American health care. According to the University of Chicago’s National Opinion Research Center, more than half of American adults have gotten at least one surprise bill at some point. And these are everyday folks with insurance, not scofflaws looking to pass the costs of their care onto the taxpayers.

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 “We’ll lose everything.”

Fortunately for them, their appeal of the bill to the office of the Washington State Insurance Commissioner was upheld. Their debt was eliminated. For tens of thousands of other Americans, the problem of surprise medical billing is a ticking time bomb waiting to go off.

A June 2019 poll of 1,500 registered voters by Morning Consult found that 81% of Americans believe health insurance companies are to blame for surprise medical billing. They’re probably right. Insurance companies 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% 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.
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Peter Roff (@PeterRoff) is a senior fellow at Frontiers of Freedom and a former U.S. News and World Report contributing editor who appears regularly as a commentator on the One America News network. Article shared by Issues & Insights - seasoned journalists behind the legendary IBD Editorials page.

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