By Hazel Trice Edney
NASHVILLE, TN— Prominent figures in the African-American community are calling on Congress to rein in large insurance companies as lawmakers look to address an increasingly urgent problem in the health care market that falls especially hard on working families, including African-Americans.
The problem is known as surprise medical billing, a situation that occurs when a patient is hospitalized and then receives a hefty bill from a doctor who turns out to be outside of his or her insurer’s network.
The practice is costing American patients tens of millions of dollars in unforeseen medical fees, at a time when many are already burdened by higher premiums and rising co-payments. Nearly half of Americans say they have avoided going to the doctor despite being sick or injured for financial reasons.
Eliminating surprise billing has long been a priority for leaders of both parties. But it is now emerging as a key issue in the 2020 Democratic presidential primary, as candidates and other leading Democrats make the case around the country for broader health care reform. Former Vice President Joe Biden invoked the need to end surprise billing in his victory speech on Super Tuesday.
As the issue comes into greater focus, prominent African-American leaders are urging candidates and lawmakers to find a solution that holds health insurers accountable for limited coverage networks and inadequate access to health insurance for minority communities – two forces, they say, that have helped create the surprise billing problem.
Addressing a group of Black ministers in South Carolina recently, Reverend Al Sharpton said solving health care issues disproportionately impacting communities of color must be atop the progressive agenda. Fixing the problem of surprise billing, Sharpton said, needs to go hand in hand with better protection of uninsured and underinsured populations.
Sharpton, who heads the National Action Network, an influential civil rights organization with roots in Harlem and chapters throughout the country, warned about a proposed bill in Congress that would potentially deepen the problem of costs being passed onto patients by giving insurers even more control over the prices they pay out-of-network doctors working in emergency hospital settings.
He said the proposed bill must be defeated because it fails to protect the underinsured and the uninsured. Dealing these specific policies that affect the disadvantaged is what is necessary in the 2020 election, Sharpton said in a recent speech at the Missionary Baptist Church in North Charleston, S.C., according to the Post and Courier.
Sharpton referred to a current bill before Congress aimed at addressing a practice known as “surprise billing,” which leaves patients on the hook for medical expenses even if they have insurance. The legislation needs to be defeated and replaced with something that would protect the underinsured and those with no insurance at all, he said, describing it as one of those “issues that’s for the good of the people.”
Dr. Benjamin Chavis, President and CEO of the National Newspaper Publishers Association and former Executive Director of the NAACP, directed even sharper criticism at insurance companies. In a piece published by Black Press USA, Chavis derided insurance executives for putting profits above patients.
“This outrageous situation benefits one group and one group alone: powerful insurance executives, who have managed to get off the financial hook for such bills, even as insurers shrink insurance coverage networks to wring more and more profits out of the system,” Chavis wrote.
Chavis expressed strong opposition to any legislation that would give insurers more control over health care prices.
Experts say surprise medical billing is most common after emergency treatment on nonsurgical hospital visits, when doctors and specialists often work together in teams to provide the care patients need. For example, in the case of an emergency procedure, a patient’s primary surgeon might be in her insurance network, but other clinicians who assist the surgeon, such as the anesthesiologist, might be out of network. In certain instances, the patients are left to foot the bill for out-of-network services.
Doctors have said that years of harmful cost-cutting measures taken by insurers are to blame. Many patients have been unwittingly pushed into highly restricted and increasingly narrow coverage networks, they say, leaving them with unanticipated costs insurers refuse to cover in full or at all. Doctors say insurance companies should be required to pay fair out-of-network rates, as determined by an independent arbitrator, for emergency care.
Insurers vehemently oppose that approach, instead calling for new rules that would enable them to limit how much they pay for emergency care provided by physicians who do not contract with them. They favor a system in which they would automatically pay median in-network rates for out-of-network services.
The dispute between doctors and insurers reached a boiling point last year, when it appeared that insurers were going to get their way. A bill modeled on legislation passed in California in 2016 would have put in place the type of benchmarking system insurance companies want.
Doctors and hospitals, for their part, raised concerns about ceding too much power to insurers to control rates. If only required to pay median in-network rates for out-of-network emergency services, the doctors and hospitals said, insurers could artificially drive down those rates by further restricting coverage networks.
Apparently, those concerns were shared by at least some members of Congress. House Speaker Nancy Pelosi is reported to have expressed serious concerns in private, saying “we are not going to give a handout to big insurance companies.” The bill was ultimately defeated.
Now, as Congress returns to the issue early into the 2020 legislative session, it appears as though the debate could be layered into a larger conversation among progressives about the future of the nation’s health care system.
The insistence of influential Black leaders that surprise bills are a symptom of a coverage accessibility problem for communities of color seems to open up a new front for Democrats looking to curtail the power of major insurance companies.