A young couple is expecting their first child. They have done everything right—installed a baby-seat in their car, assembled a crib, even checked out what hospital is in their health plan’s network. When it comes to the big day, however, the young couple gets a bundle of joy and a whopping bill for thousands of dollars! Turns out the doctor who delivered the baby actually worked for a medical staffing company that contracted with the hospital and was out of network!
When you go to the hospital, you want a doctor who will deliver the best care possible, not leave you with an unexpected bill. That is why Congress passed the "No Surprises" Act—to protect workers and their families from doctors and hospitals who get even richer at their patient’s expense. Securing this landmark legislation was not easy—the hospitals and the private equity investors they work with to come up with these revenue strategies fought the legislation vigorously. Now these same groups are trying to undermine its implementation.
Earlier this year, the Biden administration issued regulations implementing the law that would effectively limit the ability of doctors that stay out-of-network from charging five to ten times what they would get from payers like Medicare. The legislation protects workers by limiting co-pays and co-insurance to whatever an in-network doctor would charge. Physicians would still be paid, but the amount that a health plan would normally pay for in-network care. By preventing a small group of physicians from charging outrageous amounts for care covered by a patient’s plan, this regulation would help keep down insurance premiums for all working families.
This legislation and the regulations needed for its implementation address a surprisingly common problem. About one in five visits to a hospital emergency room end with an unexpected bill. The practice of surprise billing has cost working families covered by employer-sponsored insurance at least $40 billion annually.
With the regulations barring this practice set to take effect on Jan. 1, 2022, the physicians and hospitals are urging the administration to halt everything and rewrite the regulations to protect their bottom line. One group of doctors in Texas is even suing the federal government to rewrite the rules.
Last week, the AFL-CIO and other groups representing workers and consumers submitted comments arguing strongly to keep the current regulations, which we think is the only way to stop surprise bills from increasing health care premiums. We applaud President Biden for standing up to the big moneyed interests in medicine; this small step in containing health care costs will protect workers from surprise bills and higher premiums down the road!