Commentary

Roger Kahn: HHS must implement fair medical billing rules to serve Michigan’s most vulnerable

July 1, 2021 4:17 am

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The COVID-19 pandemic revealed the significant inequities in our medical system, including broken promises by private health insurers to their patients. Though some large health insurers said they would waive the costs of COVID-19 testing and care, they are now walking back these promises, charging patients and their families as much as hundreds of thousands of dollars for their treatment. 

Surprise medical billing has hurt patients for far longer than the pandemic, though. This destructive practice makes individual patients responsible for the cost of out-of-network medical bills that health insurers refuse to cover. These surprise bills can derail patients’ lives long after they recover from their illness.

In response, bipartisan policymakers in Washington passed the No Surprises Act last year. This new law was modeled around an independent dispute resolution (IDR) mechanism, which allows insurers and providers to fairly work out billing disputes. Patients will soon be protected from bills that are no fault of their own, ensuring access to lifesaving care. IDR mechanisms have been implemented successfully in New York and Texas, and I look forward to seeing them nationwide.

Now policymakers must begin the long process of implementing the No Surprises Act. I urge the Biden administration and the U.S. Department of Health and Human Services (HHS), led by Secretary Xavier Becerra, to undertake the full rulemaking process and hear from all concerned stakeholders, especially patients, physicians, and other healthcare providers. They must ensure that the best policies — in particular, a strong IDR mechanism — are implemented.

Large health insurers spent years and millions of dollars lobbying for alternative legislation that would have artificially reduced the reimbursements on which frontline providers depend. If those health insurers had gotten their way, the “rate-setting” approach they pushed would have resulted in a 20% pay cut for doctors at the height of the pandemic. 

Despite making record profits, health insurance companies are still hoping to sway regulators to enact a policy that would put their earnings above patient needs. If HHS more heavily favors insurers in implementing the No Surprises Act, frontline providers will face intense financial pressure without fair reimbursements, putting patients at risk. A robust IDR mechanism that weighs all factors equally will ensure providers are rightly compensated for the care they provide to patients.

All 9 ACA insurers return to Michigan for 2020, rates projected to fall

I served my fellow Michiganders in the state House of Representatives and state Senate for over 10 years, but I am first and foremost a physician who cares for my patients. While chairing the state Senate Appropriations Committee, I helped rewrite and pass the Healthy Michigan Bill, which has provided health insurance to hundreds of thousands in our state under Medicaid. I saw and continue to see the need for more affordable medical care in our communities.

The need for strong patient coverage is felt nowhere more intensely than in Michigan’s rural hospitals. Unfortunately, nearly a third of our rural hospitals are considered at high financial risk of closure, a concern even before the pandemic began. Even more worrying is that all but one of our state’s financially high-risk, rural hospitals are considered “highly essential” to their communities.

These “highly essential” facilities are the only hospital geographically reachable for vulnerable communities, often those using Medicaid and other safety net programs. These financially high-risk, rural hospitals also employ nearly 3,000 people and serve over 12,000 patients across Michigan annually. Rural Michiganders truly depend on these healthcare facilities. HHS should prioritize these rural and vulnerable communities when implementing the No Surprises Act.

In rulemaking for the No Surprises Act, policymakers must ensure that doctors and providers are fairly reimbursed for their care and that patients’ health care needs are served. I encourage U.S. Sens. Debbie Stabenow (D-Lansing) and Gary Peters (D-Bloomfield Twp.) to join their Senate colleagues and work directly with Secretary Becerra and HHS to ensure the agency implements the bipartisan No Surprises Act with strong and fair IDR mechanisms.

Letting health insurers lower the reimbursements providers and hospitals depend on will only hurt rural healthcare facilities, widening the coverage gap and putting the health and livelihoods of millions of Michiganders and Americans nationwide at risk. 

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Roger Kahn
Roger Kahn

Dr. Roger Kahn is an invasive cardiologist and a former Michigan state senator, representative and member of the Saginaw County Board of Commissioners.

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