It’s time to find a fix for ‘surprise medical bills’

It is a common medical occurrence. A loved one goes into the hospital for surgery. The nurses tell the patient’s family that the procedure is covered under their insurance, subject only to the deductible. Then, upon exiting the surgical bay, the recently operated-upon is met with a bill for several thousand dollars—or more. These out-of-network costs, for which the hospital unilaterally engaged (such as a second anesthesiologist) and for which the insurance underwriter will not pay, is stuck upon the patient and his or her family. Pain rendered with an unplanned, and often unaffordable, cheque.

In fact, 43 percent of all emergency department visits and 42 percent of all hospital admissions resulted in hospital out-of-network charges. The average surprise bills, according to the Goodman Institute for Public Policy Research, amounted to $628 and $2,040 respectively. Almost every where but New York. The Administration of the Empire State’s (only) African-American Governor David Patterson came up with a solution to this unplanned billing a decade ago. Leave the patient out of it.

He established a managed arbitration system, where a neutral third party judged between the excess costs that the hospital deemed necessary for safety and the funding restrictions which the insurance carrier imposed. If the arbitrator ruled in favor of the hospital, the insurer had to pay the extra, often out-of-network expenses. If the judge said that the expenses incurred proved inefficacious to the patient, the hospital had to eat the costs. Most importantly, the recipient of the surgery owed not a cent more than his or her deductible.

Louisiana’s U.S. Senator Bill Cassidy has filed reform legislation to adopt the New York’s managed arbitration system across the nation. This bipartisan bill, though, has opponents on both the Left and the Right. Progressives prefer a government-managed system with mandated prices under Medicare-for-All, and conservatives refuse to put any potential added costs on insurers, out of a fear that premiums will further increase. A common sense “Independent Dispute Resolution” process meets neither ideological imperative.

For that reason, while Cassidy’s S:1531 “STOP Surprise Medical Bills Act” undergoes “mark up” in committee, no companion legislation has been filed in the U.S. House. Even his fellow Louisiana Republican Steve Scalise has been silent, much less any of the House Democratic Leadership, which makes the possibility of passage this congressional term far more difficult.

It is easy to be skeptical about Cassidy, given his effort to repeal the Affordable Care Act, yet the physician Senator has signed on to several bipartisan measures with Democratic Senator (and Obamacare supporter) Patty Murray which could lower premiums and stabilize the ACA underwriting markets. As a doctor himself, he realizes the frustration of his patients slammed by unplanned costs while at their weakest point.

Gov. Patterson hardly came up with an original idea. The baseball fan/governor based his medical appeals process upon the appeals process used for salary negotiation by Major League Baseball, and it worked. Why can’t the nation quickly adopt a simple bipartisan solution? Why have Scalise and Cassidy’s fellow GOP members of Congress remained so silent? Moreover, why have no candidates for the legislature or Insurance Commissioner recommended this system for the Pelican State?

This article originally published in the September 23, 2019 print edition of The Louisiana Weekly newspaper.