Immigration Public Benefits

In this Aug. 13, 2019, photo, Dr. Jasmine Saavedra, left, a pediatrician at Esperanza Health Centers in Chicago, hands newborn Alondra Marquez to her mother, Esthela Nuñez, right, after examination.  (AP Photo/Amr Alfiky)

Physicians know how a single, surprise medical bill can destroy a family’s finances, forcing impossible decisions between medical care and other essentials, even driving people into bankruptcy. We routinely hear from patients whose health insurance has left them without access to affordable options and ever-growing responsibility for skyrocketing out-of-network costs and deductibles.

Physicians are no strangers to this issue. And it may surprise you to realize that we run into the same trap with ourselves and our loved ones. In an emergency or high-stress illness people do not ask whether they should expect surprises. They simply ask for medical care.

Everyone agrees patients need to be held harmless from surprise medical bills to prevent financial hardship. What hasn’t been resolved is how an anticipated federal law will direct insurers and physicians to resolve billing disputes and enter into fair contracts. Congress now faces a stark choice: Turn to a policy that risks erecting barriers to patients’ access to emergency and on-call medical and surgical care and intensifying health care consolidation, or a fair and proven approach that discourages surprise bills and settles disputes quickly and affordably, without bias toward insurers or physicians.

Doing no harm to South Carolina’s patients and the physicians they depend on requires our congressional delegation to reject arbitrary, government-mandated benchmarks developed by insurance companies and endorse a fair, proven process.

California’s surprise medical bills law is proof that well-intentioned policies can easily go awry. It uses government-mandated benchmarks to resolve disputes, which fail to consider the actual cost of medical services and set an artificial rate ceiling. This emboldens insurers to avoid entering into contracts with doctors, meaning even more physicians will remain outside of insurers’ networks. Experience has shown that creates a huge hardship for patients and is precisely what surprise medical bills legislation is supposed to solve.

With more doctors forced out of network, patients will encounter more difficulty finding an in-network doctor. When they seek care out of network, it will substantially increase their deductibles and out-of-pocket costs. Importantly, fewer hospital-based physicians, such as surgeons, obstetricians and anesthesiologists, will be able to serve patients in emergencies, a direct result of empowering insurance companies to decide how disputes should be settled. It’s not an exaggeration to assume that a policy approach that relies on arbitrary benchmarks will eventually destroy access to emergency and “on-call” safety net physicians.

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There is a solution that’s fair to patients, physicians and insurers. It’s New York’s surprise medical bills law, which is the basis for the federal policy approach offered by U.S. Reps. Raul Ruiz, D-Calif., and Phil Roe, R-Tenn. South Carolina’s congressional delegation should support it, because in New York, consumers are no longer financially responsible for payment; complaints have plummeted; premiums have grown more slowly in that state than the rest of the country; physicians’ out-of-network charges are down 13 percent; and out-of-network billing is down 34 percent, according to a recent Georgetown University analysis. In other words, New York has prevented the serious problems that arise in a marketplace, like California’s, that’s unduly dominated by insurers.

Most importantly, the New York law ensures patients can continue to see the doctors they need in an emergency because arbitration is deterring disputes from ever reaching that point. When they do, outcomes are grounded in fair, transparent and independent data, in stark contrast to California’s arbitrary, insurer-championed approach that’s adding to the ranks of out-of-network doctors and diminishing access to essential emergency physicians.

When the time comes, South Carolina’s congressional delegation should vote to prevent continued insurance company domination of our health care system, ensuring patients get the care they need at a price they can afford.

Dr. Todd E. Schlesinger is president of the South Carolina Medical Association.