By Sarah Chamberlain
As the nation collectively grapples with the challenges of the COVID-19 pandemic, I’m proud of the work our Members in Congress are doing to make healthcare more affordable for all Americans.
Health care represents one-sixth of the domestic GDP – and there isn’t a single member of the Republican Main Street Partnership who wants to see it consume even more of our economy.
I was pleased that Congress passed the No Surprises Act at the end of 2020 in an effort to end the practice of surprise medical billing – a problem whose profile has been elevated by the numerous stories of the financial impacts these bills have had on Americans across the country both before and during the pandemic.
Two-thirds of all U.S. bankruptcies are tied to medical expenses, with an estimated one in six emergency room visits and inpatient hospital stays involving care from at least one out-of-network provider. A 2019 study by the Government Accountability Office (GAO) found that the median price charged by air ambulance providers ranged from $36,400 to $40,000 – with more than 70% of those transports being treated as out-of-network, where all costs were borne by the insured individual.
Perhaps the most jarring statistic on this topic is that 20 percent of surprise medical bills issued in 2019 went to insured families who delivered newborns at an in-network hospital but had to receive out-of-network care at some point during their stay. The legislation passed at the end of 2020 is the first step toward building a system that better protects families from these bills.
The No Surprises Act is going through the regulatory process. On July 1, the Biden Administration issued the first rule implementing the legislation, which limits a patients’ financial responsibility during surprise billing scenarios. More work remains however, particularly around development of the “independent dispute resolution” (IDR) process, which is designed to keep patients out of the fights between providers and insurance companies. The Biden Administration must get this right to protect patients from unnecessary financial hardship, ensure adequate access to provider networks, and prevent insurance companies or providers from being able to game the IDR system.
Another common-sense solution to address price transparency comes out of the prior administration and is now being implemented. Patients have complained for years about the charges, prices and billing associated with our health care system. Everyone has a story about receiving a bill and not understanding what exactly was charged and what is owed. Both insurance companies and providers bear blame here, and patients are rightfully frustrated.
Since the beginning of this year, hospitals have been required to publicly post their prices as the law requires. The results thus far are disappointing. Many hospitals have not yet begun posting, while others are posting just a fraction of the information required. Very few are fully complying. Next year, this same requirement will extend to insurance companies, and it is reasonable to wonder whether this same sort of obfuscation will continue.
Given the personalized nature of health care, the complexity of the services delivered and the various insurance companies that providers contract with, most consumers understand that hospital price transparency is nothing like pricing a product on Amazon.
It would be too simplistic and unrealistic to think that the broad range of health care services can be streamlined anytime soon. But we must do better than our current system. Price transparency for hospitals and insurers is wildly popular on both sides of the aisle so there’s hope we can make progress in the current Congress.
Congress in 2016 passed the 21st Century Cures legislation, which has helped patients and their families by expediting the discovery, development, and delivery of life-saving cures in a safe and effective way.
Later this month, Reps. Fred Upton (R-MI, and a member of the Republican Main Street Partnership) and Diana DeGette (D-CO) will introduce an update to their 21st Century Cures legislation. This Cures 2.0 legislation will focus on six key areas to providers and patients alike: public health and pandemic preparedness, caregiver integration, patient engagement in health care decision-making, diversity in clinical trials, and both FDA and CMS modernization. It will include creation of a Biden administration-supported federal advanced research agency to cure cancer, Alzheimer’s and other diseases that devastate families.
The pandemic brought to light some of the challenges we face with health care in this country. These three ideas are examples of what Congress can and must do, setting aside partisan politics and rhetoric, to focus on patient-centered, market-based solutions everyone can get behind to help Main Street Americans.
Sarah Chamberlain is president and CEO of the Republican Main Street Partnership, which promotes bipartisan consensus-building on public policy issues.