For too many of us, this will sound familiar.
You or a loved one face a medical emergency or need urgent treatment and seek the nearest emergency room. The medical staff treat you, patch you up, and you get discharged. Weeks later, likely while you’re healing, you receive a bill for that medical treatment – care that you desperately needed, and that you were sure would be covered by your health insurance policy.
As a legislator, mother, and wife to a physician, I still find myself asking how does this happen? Even if a patient is experiencing a life-threatening emergency, insurance companies may refuse to cover their claims if they were treated at an out-of-network hospital, sticking patients with the bill.
To its credit, Congress is trying to wrestle with the issue of “surprise” medical billings. Yet some of the current proposals may actually make the problem worse, especially for those of us who live in rural areas, by leaning on “rate setting” – or, more simply, government dictating a framework that establishes exactly how much a health care provider can get reimbursed from an insurance company, based on the insurance company’s negotiated rates with in-network providers.
This so-called “solution” means disaster – especially for doctors and hospitals who serve rural areas.
Rate setting proposals give insurance companies all the negotiating power to control the market. They can drive down out-of-network rates by canceling existing contracts and conducting “take it or leave it” negotiations with in-network providers to significantly lower all rates. Doctors will face the unenviable choice between an unreasonably low in-network rate, or an unreasonably low out-of-network rate.
Either way, insurance companies win – while rural doctors, hospitals, and especially patients lose.
Rural health care providers – doctors, nurses, and even hospitals – face significant and growing economic challenges. The rate-setting proposals Congress is considering now would make it worse, putting doctors out of business and pushing struggling hospitals to the brink of economic collapse.
Ultimately, this means doctor shortages and hospital closures that would negatively impact the health of patients in rural communities. It means fluctuating and shrinking insurance networks, too. Any “fix” involving rate-setting will make harder for sick people to see a doctor whenever they need to.
Ensuring that everyone has access to quality, affordable health care has been one of my major goals in the Arkansas state legislature, even more so since I became Chair of the Senate Public Health, Welfare, and Labor Committee. Part of that involves recognizing that rural health care providers provide important services. For many people in low-density areas, a hospital represents the center of their health care universe.
The problems ushered in by misguided rate-setting programs will strike rural communities economically, as well. Studies show that hospital closures cause a 1% bump in a community’s unemployment rate, and a 4% dip in per capita income.
As Congress debates solutions to fix “surprise” medical billing, they must avoid any legislation that endorses rate-setting, rate-fixing or benchmarking. Any cure for surprise billing must prioritize and protect rural Americans’ access to local hospital care and emergency room services.
The uncertainty brought by rate-setting proposals would cost millions of Americans (and many of us in Arkansas) access to important, and sometimes critical, medical care. We need to end surprise billing – but in a way that makes sure everyone can get the care they need when they need it.
Editor’s note: Sen. Missy Irvin, R-Mountain View, is the chair of the Senate Public Health, Welfare and Labor Committee. The opinions expressed are those of the author.