Time for Congress to address surprise medical billing

One of the most pressing issues facing Connecticut citizens and the small businesses where they work is surprise medical billing also known as “balance billing.”  Many patients who do the right thing by going to the emergency room or in-network hospitals often are surprised when doctors or hospitals send them large, unexpected bills.

Congress now has an opportunity to make a real difference in fixing this issue by enacting S.1895, the Lower Health Care Costs Act of 2019, a bipartisan bill that will deliver better health care at lower cost, as soon it returns to Washington after the August recess.

The Connecticut Retail Merchants Association (CRMA) strongly supports this approach and joins with our other retail organizations around the country including the National Retail Federation (NRF), the Retailers Association of Massachusetts (RAM) and the Retail Industry Leaders Association (RILA) to urge Congress to act quickly to end surprise medical billing practices.   Many of our members provide quality health plans for their employees to create a productive workplace, which is good for employees and for the bottom line as well.

We believe that Congress should protect patients by eliminating these bills — and not forcing someone else to pay or rewarding providers who want to charge without regard to networks, contracts or patient care.  Retail employers believe that the solution to surprise billing is not to shift the bills to employers or insurers as that will only raise the cost of medical care for the workers and families that we cover through our plans and offerings.

This problem is real and it’s growing.  Surprise medical bills will often put large, unplanned for unpaid bills on the backs of our hardworking employees, sometimes with bills totaling thousands of dollars.  A recent study published by the Kaiser Family Foundation found that one in six Americans who have health insurance will receive a surprise medical bill from a provider or specialist who treated them after treatment in a hospital (see: “An Examination of Surprise Medical Bills and Proposals to Protect Consumers from Them” by Pollitz, Rae, Claxton, Cox and Levitt; The Kaiser Family Foundation: June 20, 2019).

The utter unfairness of these bills is made even worse because they often come as families are at their worst of times and facing uncertainty in their lives.

Importantly, not all doctors or local hospitals are the culprits behind surprise medical bills. The real issue is when clinical specialists or providers choose not to participate in health insurance providers’ networks – or if they do not meet the standards for inclusion in a network – and can then demand a blank check from patients for their services.

So instead of continuing to put our employees through a perpetual spin cycle of partisan arguments, the Senate should pass this bill to lower the cost of what Connecticut citizens pay for health care out of their own pockets.

Everyone in America deserves affordable, high-quality coverage and care, and control over their health-care choices. Surprise medical bills undermine these values, putting the health and financial stability of millions of patients at risk every year.

Connecticut retailers urge Congress to get to work on fixing this problem for patients and their families as soon as possible.  A good bipartisan, common-sense reform will include three main provisions:

• Ban balance billing in situations where patients are involuntarily treated by an out-of-network provider.
• Require health insurance providers to reimburse non-participating doctors or clinicians based on local market rates negotiated by other doctors in the area.
• Prohibit any arbitration process that increases costs for patients, businesses and taxpayers.

Employees in the retail industry, and every other Connecticut industry sector, would greatly benefit from the passage of S. 1895, as well as many veterans, those on Medicare and insurance exchanges.

Let’s make it the first order of business when Congress reconvenes.

Tim Phelan is President of the Connecticut Retail Merchants Association.