Congress Proposes Misdirected, Destructive “Surprise Billing” Legislation


The House Ways and Means Committee is trying to pass the Consumer Protections Against Surprise Medical Bills Act, which it claims will “better shield patients from bankrupting surprise medical bills.” It states that its “approach recognizes the importance of the private market dynamics between insurance plans and providers.”

“But there are no private market dynamics between physicians and plans or between patients and plans,” states Jane M. Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS). “Physicians are presented with a take-it-or-leave-it contract, and patients with a take-it-or-leave-it plan.”

The provisions in the Committee’s proposal that say they protect patient choice  only refer to their choice of “participating providers.”

“Doctors may reject the contract because of onerous administrative demands, restrictions that prevent providing the best care, or pay rates that don’t even cover costs,” Dr. Orient explained. “But with this bill, the federal government would force doctors to accept terms of contracts they have not signed.”

“People who have paid a huge premium for their insurance plan—maybe even more than their mortgage payment—are understandably outraged when they learn that it does not cover what they were led to expect,” Dr. Orient states. “They are not informed that their plan’s narrow network may mean an ‘in-network’ facility cannot provide needed services without out-of-network physicians, who bill independently.”  

“Corporations, with government back-up, will effectively dictate what patients can receive,” she noted. “If people can only pay for a Yugo or a Trabant, decent cars will disappear.”

Physician compensation is only about 8 percent of total spending. “Cutting doctors’ pay would not in itself make much difference,” Dr. Orient pointed out. “But if insurers can drive them out of business or keep them from ordering expensive care, the insurance industry will become even more profitable.”

“There is no balance bill for treatment you did not get. But rationed care might not be your preference,” she concluded.

“What we really need are honest price signals (‘transparency’) and free choice of care and of a wide variety of clearly explained insurance products.”

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties since 1943.