Pa. can’t rely on Washington to fix surprise spikes in medical bills | Opinion

By Simon F. Haeder

Before the latest lawsuit about the fate of the Affordable Care Act largely drowned out all other health policy issues, a wonky albeit important issue dominated the health policy conversation: surprise or balance billing.

These are those unanticipated bills hailing from circumstances in which consumers sought services at an in-network medical facility such as a hospital or ambulatory surgery center. And not only do they come as a surprise, they are often quite large, at times exceeding $100,000.

None of us are really safe from them. That ride to the hospital you took in an ambulance—or worse yet, a helicopter— it may not be covered.

That epidural the anesthesiologists gave you during labor, it may not be covered. That mammogram that your OB/GYN sent to a radiologist, it may not be covered. That emergency department visit when your child got stung by a bee and broke out in hives, it may not be covered.

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Not surprisingly, these unexpected bills are one of the few remaining issues that have been condemned by members of both parties.

As a result, a slew of bipartisan proposals have been introduced into Congress this year. Yet, bipartisan support and bill introductions may not amount to much real movement on the issue. Indeed, few health policy experts would be surprised if the current efforts to protect patients were to amount to nothing more than committee hearings and political grandstanding. And, of course, thoughts and prayers for everyone settled with a bill!

The reasons to be skeptical that hyperpartisan Washington, D.C. may deliver a solution for all Americans are obvious.

Who’s fighting whom?

For one, the issue is highly complex and pits three health care behemoths against each other: insurance carriers, hospitals, and individual providers like radiologists and emergency doctors.

With literally billions of dollars at stake for each, they all have mobilized their resources (read lobbyists) to protect their turf. Bound to alienate at least one of these three players, risk-averse Members of Congress have little incentive to pass anything.

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Moreover, the aforementioned ACA court case is bound to reignite tensions between Democrats and Republicans. If you are yelling and screaming at one another on one health issue, it becomes quite hard to cooperate on another. Of course, it doesn’t help that with every passing day, the next election is approaching. Passing bills may make for good policy, but not good politics.

The proposals

To make things worse, the policy proposals thrown around in Washington, DC do not really address that underlying issue that created the surprise billing issue in the first place.

Basically, all the current proposals do is shift blame—and costs—to one of the three entities involved (insurance carriers, hospitals, and individuals providers). Of course, consumers are ultimate paying the price in the form of higher premiums.

What all current proposal neglect is that the surprise billing issue emerged because of the health care system we have, a system that cares very little for patients but is focused very much on maximizing profits.

Hospitals and individual providers simply charge too much compared to what services they provide. As a famous health economist put it a few years back, “it’s the prices, stupid!”

And things have only gotten worse since then. There is a slew of consultants out there that travel the country showing health care providers how to maximize income at all costs. Deliberately refusing to enter into contracts with insurance carriers is just one of many strategies. And it works.

And what of the insurers?

Don’t get me wrong. Insurers are not innocent here either. Trying to maintain profits and enrollment, they have developed narrower and narrower networks that exclude more and more providers. Fewer in-network providers equals more out-of-network bills. The math is simple.

No doubt, Congress is the best place to solve this issue for all Americans. Yet, we may be left waiting. How long are we willing to wait when our fellow Pennsylvanians are dealing with large health care bureaucracies and thousands of dollars of bills at times when that’s the last thing they need.

Congress may or may not act on the issue down the road. For now, the best path forward goes through the Pennsylvania legislature which just showed us that bipartisan compromise is possible when it comes to protecting Pennsylvania’s health.

Why not make it two for two?

Simon F. Haeder is an Assistant Professor of Public Policy at Penn State University’s School of Public Policy. He is also a Fellow in the Interdisciplinary Research Leaders Program, a national leadership development program supported by the Robert Wood Johnson Foundation. He writes from State College, Pa.  His work appears frequently on the Capital-Star’s Commentary Page.