Last year, while still in the grip of the COVID-19 pandemic, Congress took the essential step of passing the bipartisan No Surprises law, which ended the practice of surprise medical billing. Surprise medical billing is a destructive system that holds patients accountable for the cost of off-grid medical bills that profitable health insurers refuse to cover.
The No Surprises Act was modeled on independent dispute resolution, which has been successfully implemented in New York and Texas, as it allows insurers and providers to fairly settle billing disputes. Patients will now be protected from bills that are not their fault, while ensuring access to life-saving care.
As a fellow of the American College of Surgeons and a physician in my hometown of Battle Creek, I understood the need for the final surprise billing in earnest. After the successful passage of the No Surprises Law, it is now up to the Biden administration and Department of Health and Human Services (HHS) Secretary Xavier Becerra to implement the law. It is essential that the HHS undertakes the entire rulemaking process and hears from all relevant stakeholders – patients and healthcare providers above all – to ensure that the best policies, especially a resolution mechanism independent and solid litigation, are implemented.
The big health insurers have spent years and millions of dollars lobbying Congress for their own version of the legislation that would have artificially reduced reimbursements (and increased insurer profits) upon which primary care providers depend. line. Even today, after failing in the legislative arena, health insurance companies still hope to influence regulators to establish rules that would place their profits above the needs of patients.
HHS must put in place an independent and robust dispute resolution process, as envisioned by Congress, that will allow hospitals and physicians to better serve their patients and ensure that providers are properly reimbursed for the care they provide . If HHS implements the No Surprises Act with independent dispute resolution processes that overly favor insurers and offer lower reimbursements, frontline providers will face intense financial pressure.
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In Michigan, access to life-saving medical care is under threat. Michigan has lost thousands of jobs in the healthcare industry alone since the pandemic began in March 2020. Patient volumes are still well below normal levels, not only in our state, but across the country. national. This crisis is felt intensely in rural Michigan hospitals, nearly a third of which are at high financial risk of closure.
What is particularly alarming is that rural Michigan hospitals are indispensable to their communities. These “extremely essential” providers are the only hospitals within a significant geographic radius and serve vulnerable populations, often those using Medicaid and other safety net provisions. These financially high risk rural hospitals employ nearly 3,000 people and admit more than 12,000 patients to our state each year. Residents of rural Michigan depend on these health facilities for their health and livelihoods. HHS must protect residents of rural Michigan when implementing the No Surprises Act.
Doctors, nurses and other providers have worked tirelessly to protect patients during the COVID-19 pandemic. Policymakers need to ensure that they can receive fair compensation for the intensive care they provide. Giving health insurers more power to cut reimbursements that providers and hospitals depend on will only speed up healthcare closings and worsen the shortage of healthcare providers that millions of Michiganders and Americans depend on. .
Michigan Sens. Debbie Stabenow and Gary Peters are to join their colleagues in the Senate and work directly with Secretary Becerra and the HHS to ensure the agency implements the bipartisan No Surprises Act in a way that meets the needs of patients and continuous access to quality health care providers throughout Michigan. Legislation must be implemented as intended: to protect patients, frontline providers and hospitals, not the profits of large health insurance companies.
Dr. John JH “Joe” Schwarz is Senior Lecturer in Public Policy at the University of Michigan, Physician, Former Congressman, and Past President Pro Tempore of the Michigan State Senate.