On Sunday August 22, The New York Times published an article detailing the discrepant costs of medical procedures at various hospitals throughout the country. Imagine your insurance out-of-pocket …
On Sunday August 22, The New York Times published an article detailing the discrepant costs of medical procedures at various hospitals throughout the country. Imagine your insurance out-of-pocket costs for an MRI at Lancaster General were not the same as an MRI at the Hospital of University of Pennsylvania. Most consumers would never discover this difference, because rarely does someone undergo the same procedure at two hospitals within one billing period.
As it turns out, many insurance companies have been negotiating their own prices procedure-by-procedure, hospital by hospital. Shockingly, some procedures cost less for the uninsured than for those who are insured.
If your first thought is “Thanks, Obamacare!” please read on, because you’re pointing a finger at the wrong person. Casting blame upon the Affordable Healthcare Act (ACA) is a cheap thrill that many of us have indulged since 2010, but cost transparency and standardization have nothing to do with the ACA.
Utah Senator Mitt Romney wrote the blueprint for the ACA in 2004-05 when he was the governor of Massachusetts. The ACA, like “Romneycare” before it, intended to increase coverage and primary care, and decrease healthcare spending, as well as our dependence on emergency services. Neither healthcare reform included provisions to promote transparency or standardize the cost of medical procedures. In 2010, perhaps these provisions would have been too radical or unpalatable to partisan politics, but ultimately, they support you, the patient. Cost transparency and standardization shift the legislative narrative away from powerful insurance companies. We should not fault the ACA for trying to create a public option or advancing the national conversation on healthcare. We can fault our representatives for not doing more to restrain the freewheeling, unchecked behavior of big corporations, like health insurance companies.
The No Surprises Act (H.R. 133, P.L. 116-260) prohibits surprise billing for emergency and non-emergency services and protects against fees when the hospital or doctor’s office mistakenly relies on inaccurate network status. In other words, you don’t pay if it’s not your fault. Enforcement of the law begins in January 2022.
Another law on the books will be the Transparency in Coverage final rule, which requires health insurers to create a reference list of 500 shoppable services and their out-of-pocket costs. Hospitals must share their negotiated rates with consumers, thereby revealing the inexcusable cost differences between various insurance providers. The hope is that this practice will nudge providers toward standardization without mandates. The Transparency in Coverage rule is not perfect, but it signals a movement toward consumer empowerment.
Time and time again, in the American economy of consumer goods, we see regular folks struggle because competition fails to keep the free market in check. Let Disney charge you an arm and leg for a cruise. At least they tell you how much it will cost before you set sail, but I’m not targeting luxury cruises, or your favorite egg salad sandwich for $3.95 at Pop’s Diner. Consumer goods are the things we can’t live without, some more tangible than others. Healthcare, kitchenware, food, gas, diapers, etc. In 2021, I would add internet, Wi-Fi and cell service to that list. If individuals and families can’t make ends meet, then that suggests we have an economic imbalance which favors mega-corporations and senseless tax policy. Our representatives, on both sides of the aisle, are long past due in writing stronger regulatory policy and creating enforceable oversight to rein in corporate greed. Unfortunately, this imbalance pervades many private sector industries besides healthcare alone.
Find Part Two in the editorial pages of next week’s River Reporter.
Noah Kaminsky is a middle school science teacher and a youth sports coach. He believes a party of peeps is more powerful than one of inactive sheeps.