Every day in Arkansas a new mother finds herself afraid to walk to the mailbox, worried about the arrival of another unexpected medical bill. A senior citizen is afraid to tear open the bill from a recent hospitalization. A cancer survivor is struggling financially to deal with treatment expenses he or she did not expect.
Receiving an unexpected medical bill is a real and serious problem for countless Arkansans and sick patients all across the country. These surprise bills often lead to worry, confusion, and financial hardship for patients at their most vulnerable time.
Surprise medical bills most often appear when a patient in crisis visits an emergency room that is not part of their insurance network, or they unknowingly receive a treatment or test from a medical provider not in their network. Instead of covering medical costs for patients who pay their insurance premiums every month, many of whom have no choice but to visit the closest emergency room or medical facility, insurance companies refuse to pay the medical provider and pass the bill on to the patients, citing that the provider was "out of network."
Currently, bills are pending in Congress that attempt to address the issue of surprise medical billing by setting rates for medical providers. While I applaud Congress for recognizing this important issue and attempting to address it, the proposed solution of setting fixed rates will likely do more harm than good--especially for those in rural Arkansas.
Instead of addressing the primary causes of surprise medical bills--lack of meaningful competition in the insurance marketplace and lack of a fair negotiating process between insurance companies and providers--current efforts on the federal level want to set across-the-board rates for medical services. A rate-setting scheme, while a simple solution, is contrary to our free-market economy, which is supposed to foster competition in order to receive the best product and service at the best price. Ultimately, such a simple solution to a complex problem that involves multiple stakeholders, including the insurance companies, medical providers, hospitals, and consumers, will likely do more harm than good for medical providers and consumers.
So who stands to benefit most from the current rate-setting solution being proposed in Congress, you may ask? Simple. Big insurance companies and their shareholders. Allowing fixed across-the-board reimbursement rates for medical providers gives big insurance companies massive power to dictate reduced rates to providers, which ultimately helps the bottom lines of the insurance companies and puts more money in the pockets of their shareholders.
While this rate-setting scheme may reduce the overall cost of care, if history is any indicator, the cost of health insurance premiums for consumers will continue to rise, and the reduced rates to providers will likely result in fewer hospitals, doctors, and pharmacists to take your insurance.
In rural Arkansas, hospitals, doctors, and medical providers are already operating on extremely thin margins. According to a recent Navigant study on rural hospital sustainability, more than a third of Arkansas' rural hospitals are at high financial risk and are in danger of closing. Allowing insurance companies to dictate reduced rates to medical providers will likely cause hospitals and medical clinics in rural areas to close.
When hospitals close, entire communities suffer--jobs are lost and lives are put in danger. Without access to a local hospital or medical provider, those in need of emergency medical care may have to drive hours to reach the closest medical provider--including in the event of a heart attack, stroke, or other medical crisis.
The drive to stop surprise medical billing is, at its core, a consumer protection issue. As a legislator serving in the Arkansas House of Representatives, I've proudly stood up for Arkansans as a consumer advocate. That's why I want to encourage you to join me in calling on Congress to reject proposals that are attempting to fix surprise medical billing through rate-setting. As stated above, these proposals are bad for our health-care system, bad for medical providers, and most of all, will endanger our sick, our elderly, and our children by potentially denying them access to care.
The bottom line is that every single one of us is a past, present, or future consumer of health-care services--and each of us stand to be hurt by this legislation.
Surprise medical billing is a problem that needs a solution. The priority for lawmakers should be finding a solution that actually protects consumers as opposed to maximizing profits for insurance companies.
Other solutions exist--such as requiring insurance companies to submit to a fair and independent resolution process to solve billing disputes between doctors and insurance companies, increasing transparency for insurance companies by requiring them to clearly state upfront what is and is not covered under their policies, and increasing competition in the insurance marketplace--solutions that preserve our free-market principles, protect access to care, and ensure that everyone is treated fairly in the process.
State Rep. Jimmy Gazaway of Paragould represents District 57.
Editorial on 11/09/2019