Thread by @Arnold_Ventures

#COVID19 has underscored the health care affordability crisis facing Americans & the need for #surprisebilling protections. Congress has already developed effective bipartisan compromise solutions that can be enacted now. (Thread)
arnoldventures.org/stories/debunk… @MarkMiller_DC @a_spratt

President Trump said providers receiving funds from the $100 billion #COVID19 bailout fund must refrain from #surprisebilling, but questions remain on implementation, and even with that, major gaps in patient protections remain.

A small subset of providers engage in #surprisebilling. They are often generated by private equity-owned physician groups who charge patients 500-800% more than Medicare rates for out-of-network services.
This was price gouging before #COVID19.

At the same time, these same firms are laying off providers or cutting their pay — while simultaneously asking for federal funding from the hospital bailout fund. propublica.org/article/medica…

Congress needs to enact legislation that:
-Prohibits all providers from directly billing insured patients.
-Limits what these providers are paid when they present their surprise bill to the insurer. #surprisebilling

The most effective approach is a payment benchmark requiring insurers to pay providers a local, market-based rate, resulting in savings to consumers, employers, and taxpayers — and already included in several bipartisan bills that advanced out of House and Senate committees.

Opponents to this approach have asserted a number of myths about surprise billing and this proposed solution. Let's debunk those:

Myth 1: Insurance companies — more than any other group — stand to benefit from the windfall in savings that would result from establishing a locally-based market rate for out-of-network care.

Reality: The savings from a benchmark approach would lead to lower premiums for consumers and employers, higher wages for families, and savings to taxpayers.

#Surprisebillng has inflated premiums by more than 3 percent, roughly a $40 billion increase in health care costs annually, according to research by @zackcooperYale and colleagues.

And the link between health care premiums and wages has been well-established:
nber.org/papers/w5525.p…
nber.org/papers/w11160.…

Private equity firms reap so much in profits from #surprisebilling that they have engaged in an aggressive $53 million lobbying and ad campaign to stop Congressional action: politico.com/news/2020/01/0…

Myth 2: Using a locally-based market rate to end #surprisebilling would massively disrupt the health care system, resulting in clinician shortages and potentially even hospital closures.

Reality: Even the proposals with the largest spending reductions affect only a small share of overall provider revenues and the subset of physicians who routinely engage in #surprisebilling. These physicians would be paid reasonable, market-based rates.

Surprise bills are a small fraction of business for most hospitals and providers, and current proposals do not cut funding to federal health care programs such as Medicare, Medicaid, and the Children’s Health Insurance Program.

Myth 3: The benchmark approach uses “government rate-setting” to fix surprise billing.

Reality: Current solutions to fix surprise billing rely on market rates set through negotiations between providers and insurers to determine the payment for out-of-network services.

Surprise billing has arisen from a clear market failure. Providers are highly consolidated with significant market power. Some, often backed by private equity, gain additional leverage by remaining out-of-network and “balance billing” patients.

A locally-based market rate would reflect local market forces and in-network rates and add a level of certainty and predictability to payment for out-of-network care for insurers (who will build uncertainty into rates), providers, and American families.

The alternative solution pushed by some providers — arbitration — adds more complexity, uncertainty and bureaucracy, resulting in increased administrative costs that will be paid by consumers, employers, and taxpayers.

.@MarkMiller_DC, @a_spratt and Erica Socker explore these myths and realities in more detail here: arnoldventures.org/stories/debunk… @a_spratt @MarkMiller_DC

It's time for Congress to finally act — in the face of a pandemic — for American families and taxpayers. Protections are needed now more than ever for all patients. arnoldventures.org/stories/debunk…