Senator Shaheen Should Protect Patients, Not Insurance Profits
By Representative William M. Marsh MD
Earlier this week, Senator Jeanne Shaheen urged Congress to protect patients and pass a fix to end surprise medical billing. She’s right. Patients shouldn’t be held responsible when insurance companies drop doctors from their networks or raise their copays.
But Senator Shaheen still hasn’t told her constituents how she would solve the problem – and addressing it the wrong way would hurt both patients and our country’s healthcare system. Both the House and the Senate are currently considering bills to stop surprise medical bills by tying payments to the geographic median in-network rate. These rate setting proposals may sound like a good idea, but they would actually be a windfall for large insurance companies without addressing the underlying cause of surprise medical bills.
Emergency departments are rightly required by law to treat every patient, regardless of their ability to pay. Hospitals and emergency departments rely on reimbursements from insurance companies to offset the cost of this lifesaving care. But a recent projection from the Congressional Budget Office found that rate-setting proposals could lower reimbursement payments to hospitals and doctors by more than 20 percent.
This could have disastrous consequences for vulnerable hospitals here in New Hampshire. According to a recent study, almost 30 percent of New Hampshire’s rural hospitals are at high risk of closing. Across America 430 rural hospitals in 43 states are at high risk of closing. Lower reimbursement payments could be the death knell for these critical care providers that are already struggling to keep their doors open.
Consider also the potential effects on our local communities if one of our NH hospitals is pushed over the edge and closes due to this misguided proposal. Consider the impact of your local hospital on the local economy. Consider the impact on property values if a community lacks emergency medical care and is no longer an attractive place to live.
Insurance companies are making record profits. For example, UnitedHealth is expected to make more than $275 billion in revenue in 2021. Meanwhile, 85 rural hospitals have closed since 2010, leaving scores of communities without access to emergency care.
California passed a rate setting law in 2016, similar to legislation Congress is currently debating. The consequences have been dire for local doctors and patients. According to a recent letter from the California Medical Association, “insurers are terminating long-standing contracts with physicians or mandating significant rate cuts, and therefore, patient access to physicians is diminishing and patient costs will increase.” If Congress passes rate setting, insurance companies will jump at the opportunity to terminate contracts with physicians and shrink their networks. This makes it more likely that patients receive surprise bills.
Thankfully there is a better solution. Doctors and physicians overwhelmingly support a solution that creates an independent dispute resolution (IDR) process for insurers and providers to negotiate a fair payment for medical bills. This solution takes patients out of the middle of disputes and ensures that providers receive adequate payment for the lifesaving treatments they provide.
New York and Texas have both recently passed laws instituting IDR and the results speak for themselves. A report just released by the New York Department of Financial Services found that between 2015 and 2018 IDR has successfully mediated thousands of disputes, decreased out-of-network costs by more than 34 percent and has saved patients more than $400 million. Texas and New York don’t agree on much politically, but both states realize that IDR is the best method to protect patients from surprise medical bills without hurting the very doctors and hospitals who provide lifesaving care.
Several physicians serving in Congress have put forward draft legislation that establishes IDR as a solution to end surprise medical billing because they know what works best for doctors and patients.
Senator Shaheen decries the role that money plays in politics. But what she didn’t tell her constituents is that she has taken more than $69,000 in donations from BlueCross BlueShield during this election cycle and more than $789,000 from lobbyists in her political career.
Both as a doctor and as Trustee and former Treasurer of a critical access hospital, I understand how these issues impact all parties. Both doctors and our not-for-profit hospitals have the best interest of patients at heart, while insurance companies are looking to increase their already record profits. Senator Shaheen should fulfill the oath she took to her constituents by protecting doctors and patients, not her powerful insurance donors.
(William Marsh is serving his second term in the NH House of Representatives and is a retired ophthalmologist and a Trustee of Huggins Hospital. He and his wife, Stefanie, live in Brookfield.)