America’s conservative and free market think tanks have declared their unanimous opposition to price controls, as Congress and the Trump administration discuss legislation to address "surprise billing" in healthcare.
That’s according to a June 9 letter signed by 26 such groups to President Donald Trump, Vice President Mike Pence, Health and Human Services Department Secretary Alex Azar, Centers for Medicare and Medicaid Services Administrator Seema Verma, and Brooke Rollins, the recently installed Director of the Domestic Policy Council.
They warn that proposals to resolve billing disputes with a "rate-setting" system are "fatally flawed" and would cause "devastating" shortages, disruptions, and large-scale consolidation and reduced competition in the healthcare sector.
"Any mandates or price controls would make surprise billing problems worse and disrupt care for millions of patients across the country. These effects would be particularly devastating as the COVID-19 pandemic continues to claim far too many lives. We therefore urge you to reject rate-setting and embrace market-oriented solutions to solve the pressing problem of surprise medical billing," the letter says.
“Surprise billing” occurs when patients mistakenly or unknowingly accept medical care from an "out of network" physician or facility not covered by their health insurance plan. They subsequently receive eye-popping bills to pay for the services out of pocket.
The severity of surprise billing has significantly worsened in the years since Obamacare was enacted into law, as insurance companies have become increasingly stringent in enforcing complicated rules about which facilities and physicians are considered "in network."
The letter follows a previous effort by these activist groups, which have organized on the issue under the moniker "the Coalition Against Rate-Setting" (CARS), in which 160 economists warned against the unintended adverse consequences of including price controls in legislation to address surprise billing.
"No matter the policy area, government price controls often result in shortages and market distortions," the economists wrote in the April 28 letter, which was sent to Trump as well as congressional leadership from both parties.
Recent news reports have suggested that legislation under discussion may not resolve how billing disputes that arise from a law against surprise billing would be resolved.
The groups describe this reporting as giving cause for "cautious optimism," but note that significant players in the debate over surprise billing, including Republicans, have previously pushed hard to include price controls in their proposals.
"We recognize that much remains to be negotiated," the groups write.
Under the price controls proposals in question, whenever there is a dispute over who should pay for a given health care expense, and at what price, the dispute is resolved by forcing both parties to accept (or pay) a government-set "benchmark" rate for the services.
In 2017, California adopted "benchmark" rate price controls in its state-level fix to surprise billing. The results, according to academic research that analyzed the impact of the law, has not been pretty, the groups note.
"According to a 2019 American Journal of Managed Care study examining the law, rate-setting has led to healthcare facilities closing their doors and merging with other, larger practices. Doctors are even contemplating leaving California altogether," the letter says.
See the full text of the letter below:
To: President Donald J. Trump, The White House, 1600 Pennsylvania Avenue, NW, Washington, D.C. 20500; The Honorable Alex M. Azar, Secretary, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, D.C. 20201; Vice President Michael R. Pence, The White House, 1600 Pennsylvania Avenue, NW, Washington, D.C. 20500; The Honorable Seema Verma, Administrator, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244; Brooke Rollins, Assistant to the President, Director, Domestic Policy Council, 1600 Pennsylvania Avenue, NW, Washington, D.C. 20500
President Trump, Vice President Pence, Secretary Azar, Administrator Verma, Mrs. Rollins:
On behalf of millions of taxpayers and consumers across the United States, the Coalition Against Rate-Setting (CARS) urges you to oppose price controls on the healthcare system. For the past year, some members of Congress and some individuals in the Trump administration have repeatedly floated the idea of "fixing" the pressing problem of surprise medical billing through a "rate-setting" system. These fatally flawed proposals would have Washington, D.C. bureaucrats dictating to doctors the prices they should charge patients. Recently, Politico reported that the administration is considering a plan that would, "outlaw health care providers from putting patients on the hook for thousands of dollars in expenses -- but without mandating how doctors and hospitals would recover their costs from insurers."
While such reporting gives cause for cautious optimism, we recognize that much remains to be negotiated. As such, the Coalition would like to reiterate that any mandates or price controls would make surprise billing problems worse and disrupt care for millions of patients across the country. These effects would be particularly devastating as the COVID-19 pandemic continues to claim far too many lives. We therefore urge you to reject rate-setting and embrace market-oriented solutions to solve the pressing problem of surprise medical billing.
During the worst public health emergency in our lifetimes, millions of patients across the country have found themselves in emergency rooms and healthcare clinics. Many of them reasonably assumed their troubles would be over after being discharged, only to receive a surprise medical bill in the mail days or even weeks after being discharged.
Each year, 1 in 7 patients in the U.S. receive these unwanted, unexpected expenses after being sent home by their doctors. This devastating problem stems from increasingly narrow health insurance networks which increasingly refuse to compensate attending doctors at in-network medical facilities. Far-reaching pieces of legislation such as the Affordable Care Act (aka Obamacare; signed into law in 2010) have simply made the problem worse, and now, an estimated three-quarters of Obamacare plans feature narrow insurance networks.
Yet, despite federal interventions and regulations making the problem worse, some government officials want to double-down on bureaucratic control over the healthcare system. Members of Congress such as Sen. Lamar Alexander (R-Tenn.) and Rep. Frank Pallone (D-N.J.) have proposed rate-setting for doctors and repeatedly tried to insert this "fix" in Coronavirus-related relief legislation. Officials in the Trump administration have worked hard to get a thorough understanding of this issue and deliberate on their own plan to end unwanted medical expenses. But rate-setting would only make the problem worse, and lead to the widespread consolidation of hospitals, clinics, and doctor's offices across the country. California has already tried this failed approach, implementing healthcare price controls in 2017. According to a 2019 American Journal of Managed Care study examining the law, rate-setting has led to healthcare facilities closing their doors and merging with other, larger practices. Doctors are even contemplating leaving California altogether.
On January 22, 14 advocacy groups and think-tanks formed CARS to warn lawmakers and the Trump administration about the myriad unintended consequences of rate-setting. CARS is now 34 groups strong, and its work has been cited extensively by national and state media. On April 28, CARS released a letter signed by more than 160 economists urging officials to reject healthcare price-controls.
CARS urges you to take these scholars' arguments into account, and remain vigilant against federal overreach in the healthcare system. Millions of doctors are on the frontlines of the COVID-19 pandemic treating patients, and now would be the worst possible time to impose onerous price controls on them. Thank you for your time and consideration of this pressing issue.
Sincerely,
Tim Andrews, Executive Director Taxpayers Protection Alliance
Christopher Sheeron, President, Action For Health
Bob Carlstrom, President, AMAC Action
Brent Wm. Gardner, Chief Government Affairs Officer, Americans for Prosperity
Norman Singleton, President, Campaign 4 Liberty
Ryan Ellis, President, Center for a Free Economy
Andrew F. Quinlan, President, Center for Freedom and Prosperity
Jeffrey L. Mazzella, President, Center for Individual Freedom
Thomas Schatz, President, Citizens Against Government Waste
Twila Brase, RN, PHN, President & Co-Founder Citizens' Council for Health Freedom
Matthew Kandrach, President, Consumer Action for a Strong Economy
Jason Pye, Vice President of Legislative Affairs, FreedomWorks
George Landrith, President, Frontiers of Freedom
Saulius "Saul" Anuzis, President, 60 Plus Association
Mario H. Lopez, President, Hispanic Leadership Fund
Andrew Langer, President, Institute For Liberty
Harry C. Alford, Co-Founder, President/CEO, National Black Chamber of Commerce
Pete Sepp, President, National Taxpayers Union
Robert Fellner, Vice President & Policy Director, Nevada Policy Research Institute
Wayne Winegarden, Ph.D, Senior Fellow & Director, Center for Medical Economics and Innovation Pacific Research Institute
Joshua H. Crawford, Interim Executive Director, Pegasus Institute
Renee Amar, Vice President for Policy and Government Affairs, Pelican Institute for Public Policy
Paul Gessing, President, Rio Grande Foundation
Robert Alt, President & CEO, The Buckeye Institute
David McIntosh, President, The Club For Growth
James Taylor, President, The Heartland Institute
James L. Martin, Founder/Chairman, 60 Plus Association
Jessica Anderson, President, Heritage Action For America
