Dr. Nicole Saphier: Coronavirus hit health care workers hard, and this legislation would make it worse

Nearly six months after COVID-19 began to ravage our communities, there are three constants: the threat of the pandemic remains prevalent, frontline health responders and other essential workers continue tirelessly, and politicians are finding ways to exploit the crisis to benefit special interest groups. 

Over the last few months, hundreds of U.S. health care workers have already died from COVID-19.  Nonetheless, nurses, doctors and many other medical personnel continue their efforts while acknowledging the risk that accompanies their jobs.

Meanwhile on Capitol Hill there is a renewed effort to include legislation in any new COVID-19 relief bill that would show politicians’ since appreciation for doctors and other service providers by essentially CUTTING their pay. Historically, there has been a push by members of Congress to rate set for out-of-network coverage which effectively punishes doctors in a misguided attempt to solve for what some call “surprise medical billing” 

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The goal is laudable and one that we can all support — patients should not be the ones stuck in the middle of billing disputes. And no patient should go bankrupt for emergency medical procedures.

The balance occurs when a patient receives a bill for the difference between the cost of the medical service and what their health insurer is willing to pay, so really it should be called “surprise insurance denial” rather than “surprise medical billing.”  

What we continue to see are insurance companies playing their usual games in order to either squeeze patients or health care providers by not covering the cost of services provided. Turning to government rate-setting is akin to putting money in the pockets of the Goliath health insurance companies rather than paying the doctors and other personnel for services rendered. They do this by keeping reimbursement rates so low that doctors and other medical service providers are forced to further consolidate or stop taking insurance altogether. 

In the last two weeks, three health insurance conglomerates have reported blockbuster earnings. UnitedHealth had its most profitable quarter in history. Anthem doubled its profit from Q2 in 2019. And Cigna beat Wall Street expectations. The Wall Street Journal captured it best when the paper proclaimed in a headline “Health Insurers’ Coronavirus Boost Is Likely to Last”. 

At the same time, hospitals across the country are cutting pay to physicians and staff to offset the losses accrued during the current pandemic. Our country cannot afford to financially hurt our medical service providers any further with the proposed out-of-network legislation if we want them to stay in business.

The impact of government rate setting will be felt the most in rural areas of this country where quality medical care is scarce to begin with. Faced with budget constraints, providers will need to cut services, hospitals will cost-shift and even air ambulances, which are particularly critical in rural America, will need to close airbases. 

Americans cannot be faced with a care shortage crisis right now. If COVID-19 has taught us anything it is the role that high-quality health care plays in keeping this country safe. Too many regions in our country are already feeling the effects of hospital closures in their communities from reimbursement cuts. That will only be exacerbated if the medical community is hurt financially because of the surprise insurance denial legislation that’s currently being discussed. 

Meanwhile, there are two groups that benefit greatly by this — health insurers and the politicians who receive the industry’s very generous contributions.

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If the out-of-network legislation goes through, the insurance companies will be popping a cork with their Washington, D.C., allies, as politicians are also beneficiaries when insurance companies profit. BlueCross BlueShield has contributed more than $2.6 million to Republicans and Democrats this cycle, and Cigna has kicked in another $1 million plus to their friends on Capitol Hill.

What do those eye-popping numbers buy the industry? The ability to exploit a crisis. While doctors, nurses, hospital staff and EMTs continue to descend on the hardest-hit areas across the U.S., we now see what the health insurers were up to.

They dispatched their well-paid army of lobbyists to infiltrate Washington, D.C., and work with their pawns in Congress to concoct a scheme — a scheme that will inflict direct consequences on our frontline heroes. 

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The torment doesn't stop with this proposed bill either. The pause in elective procedures from the pandemic devastated an already struggling system, and the impending Medicare payment cuts will push recovery further away if they aren’t stopped.

Congress and the White House should be finding ways to protect our health responders as COVID-19 continues to demand their resources, not empowering health insurers to continue their deceitful and destructive practice of surprise insurance denial.

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