Bakersfield is lucky to have a leader like Assemblyman Vince Fong representing our interests in Sacramento. His recent op-ed calling for congressional action on the issue of surprise medical billing hits the nail on the head ("COMMUNITY VOICES: Protecting California patients from surprise medical billing," Sept. 26). Far too many patients suffer under this unfair billing practice, so it is well past time for Congress to act. However, it is critical that any legislation lawmakers pass does not negatively impact health care facilities and providers in Bakersfield, across California and throughout the nation.
Current legislation in the House of Representatives, known as the No Surprise Act, seeks to blend two competing approaches to tackle the surprise medical billing problem: benchmarking and Independent Dispute Resolution (IDR). Benchmarking would involve the government setting low fixed-rates for all physicians. Not only does this approach ignore the differences in the difficulty and cost of providing clinical care across different geographical regions and in various types of healthcare facilities, but it would remove incentives for insurers to engage in fair negotiations with physicians in order to expand their provider networks.
Continuing to allow insurers to shrink rather than expand provider networks will only lead to higher rates of surprise medical billing and compound our nation’s already notable doctor shortage. Such a short-sighted approach would be particularly devastating for rural health care in California and throughout the nation, potentially forcing many at-risk hospitals and emergency rooms serving these hard-to-reach patients and communities to close their doors completely, further undermining access and driving up costs for vulnerable patients.
That is why Congress should focus on solutions that employ a true IDR framework — such as the STOP Surprise Medical Bills Act in the Senate. IDR leverages free-market principles to allow insurers and providers to negotiate out-of-network payments through a simple, transparent online process overseen by a neutral, third-party mediator. The IDR process protects patients from surprise medical bills while maintaining the strength and stability of our local hospitals, emergency rooms, and other health care facilities.
For proof of its success and efficacy, Congress only needs to see how well IDR has worked in New York, where it has been law of the land since 2015. In that time, it has helped eliminate surprise medical bills for patients while increasing network participation, lowering out-of-network billing rates by 34 percent, reducing emergency care costs by 9 percent and saving New Yorkers $400 million. Even the New York Health Plan Association has noted their support of the IDR process. This is the kind of success that we need to be seeing on the national level.
Everyone agrees that patients should not get caught in the middle of lengthy, complicated out-of-network billing disputes between their health care providers and insurance companies. Yet, Congress must avoid misguided approaches that could further undermine health care access and affordability. For that reason, Minority Leader Kevin McCarthy and the rest of California’s congressional delegation should oppose legislation that includes benchmarking and focus on passing a solution that incorporates a true, IDR-focused framework to protect patients while keeping health care strong here in Bakersfield and throughout the nation.
Nick Ortiz is the president and CEO of the Greater Bakersfield Chamber.