Every year, hundreds of Utahns are impacted by surprise medical bills. These bills often occur when a patient is rushed to the nearest emergency room during a crisis, to a facility that is not covered by their insurance network.
For example, in 2018, Salt Lake native Lisa Ray’s 16-year-old son suffered a broken jaw while playing rugby. Unfortunately for her, her local, in-network hospital was at capacity, forcing her to go to the out-of-network McKay-Dee Hospital to admit her son into emergency surgery. Ray was subsequently billed $41,000 for the transaction, and her insurance provider only covered $14,000, ultimately leaving her family on the hook for $27,000.
The people of Utah should not have to deal with horror stories like this one. Utah legislators such as state Rep. Jim Dunnigan, R-Taylorsville, have been pushing for solutions to the issue within the state legislature since 2017. Now Congress is getting involved, and lawmakers are heading in the wrong direction.
The Committee on Health, Education, Labor and Pensions in Washington, which Sen. Mitt Romney sits on, is pushing legislation, called the Lower Health Care Costs Act (LHCC).
The LHCC aims to solve the tragedy of surprise medical bills by imposing a nationwide system of price controls. As it currently stands, hospitals charge two different rates for their services: in-network and out-of-network rates, with the latter often being substantially higher. The new bill in Congress would mandate that hospitals effectively terminate that practice, forcing doctors and physicians to accept the median in-network rate as compensation for all out-of-network bills.
This change would have devastating consequences. The LHCC’s price controls would compel hospitals to accept less revenue without any avenue for recompense. Consequently, care facilities would be forced to make painful adjustments, including laying off staff and reducing service. Consumers would be left with fewer viable healthcare options.
The bill’s passage would be particularly devastating for Utah, which already has a significant shortage of health care providers. According to the 2018 Medical Health Plans report, the state has the second most overworked nurses and fourth most overworked doctors in the country. Should the LHCC pass, more doctors will leave the state, and this problem will only get worse. Patients will face higher costs and less access to care.
In short, LHCC’s price controls may work for the health insurance companies that have an interest in spending as little on coverage as possible, but it will not work for anyone else.
Rather than impose price controls that punish doctors and hospitals, and consumers, Congress should consider independent dispute resolution (IDR). Through IDR, an arbiter would accept best-price proposals from hospitals and insurers. He or she would then make an assessment on what is fair based on what they present. To consumers’ benefit, this process will tailor solutions to surprise medical billing on a case-by-case basis – something that that arbitrary price controls cannot be said to do.
One senator in Washington, medical doctor Bill Cassidy, R-La., has already taken up the mantle of arbitration. He has introduced bills that would address the issue of surprise medical billings in a way that does not destroy the foundation of the health care industry. Cassidy’s legislation, which includes the Stopping The Outrageous Practice of Surprise Medical Bills Act, are commonsense alternatives to radical steps like the LHCC. Utah lawmakers must promote measures like independent arbitration to protect patients and medical providers alike.
Surprise medical billing is a serious problem that must be addressed. Utahns owe it to themselves to find a solution that will work for their medical needs. The LHCC does not represent an effective remedy. Romney, and the rest of Utah’s federal lawmakers, should oppose the scheme.
Robert Bell
Robert Bell is a small business owner who lives in Salt Lake City.
