Before I left office as State Representative early this year, I heard from numerous constituents who were frustrated that they were paying for insurance and meeting their deductible, but still being asked to pay hundreds or even thousands of dollars in extra bills that they had incurred out-of-network, without their knowledge. Rising costs and diminished access, especially in rural areas, create often insurmountable barriers for patients in need of care. Surprise medical billing only exacerbates the problem, adding new financial burdens for patients and their families.
No one who has recently sought medical care should have to be forced into the middle of a billing dispute between their insurance company and health care provider. Yet, thanks in large part to insurers that continue to shrink provider networks, the practice is becoming more and more commonplace. This is a national problem that requires a federal solution from Congress.
However, in solving for surprise medical billing, Congress must exercise caution to avoid infringing on the free market’s ability to deliver lower prices and improved outcomes while ensuring patient access to high-quality care is not compromised in the least. Currently, one of the legislative vehicles Congress is considering would do both.
There are some ideals conservatives should not budge on—and that includes upholding and protecting the free market. That’s why it is concerning to me that a dangerous proposal known as benchmarking is gaining traction in Congress, with the help of some notable conservative lawmakers. Benchmarking would put federal bureaucrats in Washington in charge of setting rates paid to physicians across the country.
Not only does this violate the free market by allowing the government to dictate rates paid to physicians, but it would threaten patient access to care. By setting arbitrarily low rates that skew the marketplace, benchmarking would slash reimbursements to doctors, creating monumental financial losses that get foisted upon local hospitals and emergency rooms. For facilities operating in remote, rural areas, budgets are tight enough as it is; these losses could spell disaster as many rural hospitals may be forced to close down altogether, leaving patients with fewer choices, higher costs, and less access to the quality care they need.
There is simply no good argument for government rate setting that would happen under benchmarking. Instead of pursuing this misguided approach, Congress should look to another legislative proposal that includes the Independent Dispute Resolution (IDR) process. IDR embraces the free market, encouraging both providers and insurers to negotiate fairly and openly in order to reach a final payment amount.
The entire process happens online and is administered by a third-party, independent mediator. Until a final decision is reached, providers receive interim payment equal to the fair market value of their services. That helps provide stability and security for rural hospitals to ensure the seamless delivery of quality care for patients.
Ultimately, IDR is the most effective solution available and will help the health care market function better—as it is already doing in New York, which implemented it in 2015. Both Senators Roy Blunt and Josh Hawley should back this proven, free-market approach and work to incorporate it in the final bill Congress passes to eliminate surprise billing for good.
Former-Rep. Donna Lichtenegger, who represented HD 146, served for 8 years in the Missouri House.