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Empty beds in the emergency room await patients at Sunrise Hospital on Wednesday, Jan. 31, 2018. (Daniel Clark/The Nevada Independent)

By Peter Guzman

Few issues affect Nevada’s residents and businesses more than the rising cost of health care. Under the larger umbrella of health care is a lesser known, but just as pressing issue that also affects patients and families struggling to keep up with these increasing costs. Surprise medical billing is a problem here in Nevada and across the country—which is precisely why it is up to our elected officials in Washington to fix it. However, Congress must solve this problem without creating new roadblocks that impede access to quality care.

If you have ever received out-of-network care at an emergency room or hospital, you’ve likely already been affected by surprise medical billing—just like 57 percent of Americans, according to a University of Chicago study. It happens weeks after receiving care as patients already struggling with illness or other medical issues are slapped with excessive bills demanding payment for the cost of care not covered by their insurance plan. It can even happen at an in-network facility if the doctor treating you happens to be out-of-network, which is a fairly common occurrence.

We can all agree that no one should be put into this position, least of all vulnerable patients. Fortunately, for its part, Congress does seem to recognize this problem and is working to pass legislation that removes patients from the equation altogether. However, some of the proposed solutions on Capitol Hill would have unfortunate, unintended consequences that would actually threaten access to health care for many patients, particularly those living in rural parts of the state and country. 

For example, one bill—S. 1895, the Lower Health Care Costs Act—would seek to remedy the surprise billing situation through a dangerous approach known as “benchmarking.” This method would essentially lead to government rate-setting, in which the federal government would set rates for out-of-network payments to physicians. In business, we call this government intrusion into the free market—and it never ends well. 

In the context of health care, putting the government in charge of determining and enforcing a one-size-fits-all payment rate for doctors would essentially ignore the fact that the cost of providing certain treatments and services may vary greatly from location to location and from facility to facility. That means many doctors would end up being short-changed for their services, and those financial losses would simply get passed on to the hospitals and emergency rooms that provide care for their communities.

In many cases, these hospitals and emergency rooms are just barely getting by as it is. The financial hit they would incur as a result of government benchmarking may prove too much for them to bear, leading to more hospital closures or consolidations. That would only further eliminate choice and threaten access to care for patients in Nevada and across the country. Yes, patients may be protected from surprise medical billing, but at what cost? There must be a better way.

And fortunately, there is. Another bill in the Senate—S. 1531, the STOP Surprise Medical Bills Act—takes a refreshingly different approach. Instead of encouraging government intrusion into the free market, this bill would employ an Independent Dispute Resolution (IDR) to resolve payment issues between health care providers and insurers. IDR is basically the same process that players and teams in Major League Baseball use to settle salary disputes. It incentivizes both sides to bring their best offers to the table and negotiate openly and transparently, with a final decision being made by an independent mediator. This is the fairest way to determine payments without jeopardizing access to care for anyone.

Our own senator, Jacky Rosen, is a cosponsor of this bill and supporter of the IDR process, and for that we should all be grateful. However, we need Nevada’s entire congressional delegation working hard to ensure the IDR framework in the STOP Surprise Medical Bills Act is included as part of any surprise billing legislation passed by Congress. It’s time to end surprise billing—but it must be done the right way.

Peter Guzman is the president of the Las Vegas Latin Chamber of Commerce.

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