Nearly a decade ago, when lawmakers guided the American public into passing Obamacare, they were working hand-in-hand with big insurance companies. The insurance industry was a willing accomplice to the health care overhaul and aggressively lobbied Congress for a beneficial final product. The result was one of Obamacare’s worst kept secrets: under the cloak of health care reform, insurance companies enjoyed a significant financial windfall.
The insurance companies are up to their old tricks once again. Legislation that could affect millions of patients is making its way through Congress – and insurance companies are trying to influence the outcome so they can add to their multi-billion-dollar profits at the expense of patients. To strongarm their preferred approach through Congress as quickly as possible, insurers created a false narrative about how to solve the problem. They have presented the solution as a choice between their preferred outcome or doing nothing at all.
This situation is not surprising. Insurers are responsible for surprise medical bills, and they do not want to be held accountable for them. Surprise medical bills happen when patients visit an out-of-network health care provider without their knowledge, such as a trip to the emergency room. Instead of covering urgent and possibly life-saving medical care, the insurance company passes the bill onto the patient. Patients who dutifully pay their monthly insurance premiums, expecting that their coverage will be there when they need it, are blindsided by a new and significant financial burden.
Contrary to the insurers’ false narrative, two competing legislative approaches are making their way through Congress. One would stop surprise medical bills by creating a fair and independent arbitration system for medical providers and insurance companies to resolve billing disputes. This system, known as Independent Dispute Resolution (IDR), has already been proven to work at the state level. Consumer feedback has been positive, and insurance premiums have remained stable. The other approach, known as rate setting, would benchmark insurers’ out-of-network payments to their in-network rate. This paradigm gives insurance companies enormous power to cancel contracts and drive down prices for their corporate gain. The result would be disastrous: doctor shortages, hospital closures, narrower insurance networks, and fewer options for patients. Rural areas, where hundreds of hospitals are already in financial distress, would be hit especially hard. California enacted a similar rate-setting approach in 2016, and insurers have already canceled network agreements to drive their financial obligations drastically downward.
Insurance companies have gone all-in to push this legislation across the finish line in Congress. They have spent $30 million on lobbying, attempting to grease the wheels of the legislative process in much the same way as they did during the Obamacare debate. They set up a multi-million dollar advertising campaign to blame doctors for surprise medical bills, even though insurance companies refuse to cover life-saving medical care for patients who have no other options. They have tried to shift the conversation about surprise medical bills by attacking the investors behind doctor staffing groups because they know they can’t win a fair debate over how to best protect patients.
And, to influence Congress and bolster their ad campaigns, insurers have funded academic researchers. These apparent conflicts of interest seem to slip by members of the media, who cite these studies in story after story as they make the insurance industry’s case for them.
Zack Cooper, a Yale University researcher, produced a study frequently cited as proof that doctors should shoulder the blame for surprise billing. The National Institute for Health Care Management Foundation (NIHSM) funds Copper; insurance industry executives comprise the board of NIHSM. Similarly, Loren Adler, from the USC-Brookings Schaeffer Initiative for Health Policy, is a frequent public critic of the IDR approach to surprise billing. Adler is associated with the University of Southern California’s Leonard D. Schaeffer Center for Health Policy & Economics, which was established by the founder of Wellpoint (now Anthem), the country’s largest health insurance company. It also counts other significant insurers like Blue Cross Blue Shield among its donors.
Major insurance companies are posting billions of dollars in profits every year. Last year, the eight biggest insurers made$7 billion in the third quarter alone. UnitedHealth care is expected to reach $275 billion in revenue by 2021. Still, insurance companies are trying to rig the system in their favor. The industry is lobbying Congress to give them the ability to drive down their obligations to patients and drive up their profits even more.
The insurance industry is running Obamacare playbook all over again. This time, they should not be allowed to get away with it.
Benjamin Alli, M.D., Ph.D., is a Sakellarides professor of medicine and surgery and the chancellor of the Royal College of Physicians and Surgeons of the United States of America.