The conservative Republican Study Committee in the House of Representatives this week released an important backgrounder for staff and members on the sticky subject of “surprise medical billing.” Their recommendation is for Congress to avoid a legislative rush to judgment on what is, for most members, a brand new issue. The RSC’s federalist modesty is not only admirable in modern clickbait culture, it happens to be the correct policy answer to the surprise medical billing question. Republican leadership and committee ranking members in the House would do well to follow the RSC’s lead here.
To be sure, the issue of surprise medical billing is a real one.
Two-thirds of respondents to a Kaiser Family Foundation poll were very or somewhat worried about unexpected medical bills. These charges happen when a patient seeks care at a hospital or urgent care facility which is in the insurance network, but, while there, receives medical services from a doctor or other practitioner who is not in-network. Very often, the patient is never told that this is happening until it’s too late, and someone who thought of doing the right thing by staying in-network ends up with a surprise medical bill weeks or months later from an anesthesiologist, a radiologist, or an ambulance service.
This “surprise medical billing” issue has cropped up in recent years as insurance companies have responded to the mandates and cost pressures of Obamacare by narrowing their networks of doctors, hospitals, urgent care facilities, pharmacies, and so on — the so-called “skinny network” phenomenon. As a result, patients find themselves out of network far more often than they did a decade ago, even when they are trying to stay in-network.
As the RSC points out, 28 states have responded to this problem by passing very different laws, which range from light government oversight and transparency to draconian state intervention. This is as it should be. The states are the laboratories of democracy and should be allowed to compete with each other to see what works best. Eventually, some best practices will emerge and crosspollinate, and the problem will be at least mitigated, if not solved — and all without making a federal case out of it.
But letting the system of federalism envisioned by the Founding Fathers take effect is rarely a satisfactory answer in the swamp of Washington, D.C.
Even though the issue is not very well understood outside of a few pockets on Capitol Hill, there are no fewer than three separate committee products on the House side alone that claim they can fix, once and for all, the issue of surprise medical billing.
One of their proposed bills, from the House Energy and Commerce Committee, mirrors legislation championed by the Senate Committee on Health, Education, Labor and Pensions. As of this writing, the three House committees are trying to merge their three bills together into one unified legislative approach.
The most well-known of these bills is the “Lower Health Care Costs Act.” The legislation would establish a series of “Medicare for all”-style price controls right out of the Bernie Sanders playbook.
It’s a huge bailout and a huge favor for Big Insurance, who would get away with paying the low, price-controlled government rate to doctors, hospitals, and ambulances. As a result, there would be a mass exodus of these medical professionals, probably starting first in sparse rural areas and low-income neighborhoods. The unintended consequences of such a radical change are even now not yet fully understood.
What’s the rush all about?
Back in December, House Speaker Nancy Pelosi created an artificial deadline of May 22 to produce a major healthcare bill. Those who want to fix surprise medical billing want to get on that legislative train, likely the last one leaving the station before this fall’s elections. As a result, lawmakers and staff are scrambling, lobbyists are lobbying, and the Beltway crisis mentality meter is dialed all the way up into the red.
Generally missing from this conversation is a frank admission of why this is a problem in the first place: the skinny coverage networks birthed by Obamacare, and embraced by Big Insurance, as a substitute for raising premiums even higher than they already have climbed.
That’s one of many reasons to hold off on rushing a bill before Pelosi’s artificial deadline. Doing this correctly is more important than doing this fast.
As the RSC backgrounder puts it:
Congress created the surprise medical billing problem by hastily passing Obamacare. They won’t fix it by hastily passing a “Medicare for all”-style patchwork coverall. Our legislators ought to slow down and remember what George Will says are the most beautiful words in our Constitution: “Congress shall pass no law.”
Ryan Ellis (@RyanLEllis) is the president of the Center for a Free Economy.
