Commentary: Congress can take surprise out of medical bills

Lawmakers are looking at two proposals to end hefty charges for unexpected out-of-network services.

By The Washington Post Editorial Board

Congress is broken. Except, in increasingly rare cases, when it isn’t. See for example a surprisingly calm and reasonable movement on Capitol Hill to eliminate surprise medical billing, a symptom of the nation’s unwieldy health-care system that saddles people with massive, unexpected financial debts stemming from the care they receive.

Too many Americans have been there. They carefully choose hospitals or clinics that are inside their insurance networks, expecting to minimize their out-of-pocket costs. Then they get hit with huge bills from, say, the doctors who anesthetized them or the radiologists who reviewed their X-rays, who are — somehow — outside their network, even though they provide services at an in-network facility. People experiencing health emergencies can have it even worse; they have no choice about the ambulances that pick them up or some of the other ancillary providers who care for them, but they have to pay their bills, regardless. Patients lack both foreknowledge about what they will be charged and the leverage to change the situation. The resulting bills can be crushing.

The blatant unfairness has moved lawmakers this year to consider acting, and the Trump administration to urge them on.

There are two major options under consideration. One, which seems to be the more popular option on the Hill, is for the government to directly regulate the prices that ancillary providers can charge. The anesthesiologist would get a payment from a patient’s insurance company equal to, say, the median payment that insurer offers specialists providing that service, while the patient would be charged no more than typical out-of-pocket costs. Or, in another formulation, the money that providers get from insurance companies could be settled by special arbiters, which would be less transparent but perhaps more acceptable to the providers. This rate-setting approach would not much threaten the business model of medical specialists, so it would encounter less opposition, yet it would still scale back the exorbitant amounts that doctors who take the most advantage of the current system currently charge.

But under this approach, medical specialists’ prices overall still might not decline as much as they should, people’s insurance premiums might remain higher than need be and the federal government might pay too much. The better approach is to require that in-network hospitals ensure that the providers to which they direct patients are also in-network, or behave as though they are. Once again, patients would encounter more reasonable out-of-pocket costs. Meanwhile, the insurers, hospitals and providers would negotiate suitable rates. This option poses more of a threat to providers’ bottom lines, and therefore could encounter more opposition. But it has more promise to drive doctors’ charges down to a fair level.

Both approaches so far have a big gap. Ambulances and air ambulances could still charge patients huge bills. That needs to be addressed in whatever bill emerges.

What cannot happen is for the momentum behind fixing these problems to wane in the midst of an election year or other unrelated political sniping. Too much sensible, bipartisan policy succumbs to such a fate.

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Opinion

toon
Editorial cartoons for Monday, June 30

A sketchy look at the news of the day.… Continue reading

Alaina Livingston, a 4th grade teacher at Silver Furs Elementary, receives her Johnson & Johnson COVID-19 vaccine at a vaccination clinic for Everett School District teachers and staff at Evergreen Middle School on Saturday, March 6, 2021 in Everett, Wa. (Olivia Vanni / The Herald)
Editorial: RFK Jr., CDC panel pose threat to vaccine access

Pharmacies following newly changed CDC guidelines may restrict access to vaccines for some patients.

Comment: Does it matter if U.S. strike on Iran was lawful?

In international and domestic law, the question may never get a clear verdict. The bigger question: Was it wise?

Comment: Justice Department’s Bove unfit for appellate court

The former Trump attorney’s record of animosity toward the courts disqualifies him as a 3rd Circuit judge.

Protesters should police behavior to maintain peace

Protesters need a police force. Not the police A police force. A… Continue reading

Trump’s Cabinet seems devoid of intellect

Something has come to mind; watching the many misadventures, lies, etc. of… Continue reading

FILE — Secretary of Health and Human Services Robert F. Kennedy arrives to testify on Capitol Hill in Washington, May 14, 2025. After firing an influential panel that sets U.S. vaccine policies, some of Kennedy’s picks to replace them have filed statements in court flagging concerns about vaccines. (Haiyun Jiang/The New York Times)
Comment: What RFK Jr. gets wrong on vaccine safety

Hundreds of studies on vaccines and their safety fact-check the HHS secretary’s false claims.

Making adjustments to keep Social Security solvent represents only one of the issues confronting Congress. It could also correct outdated aspects of a program that serves nearly 90 percent of Americans over 65. (Stephen Savage/The New York Times) -- NO SALES; FOR EDITORIAL USE ONLY WITH NYT STORY SLUGGED SCI SOCIAL SECURITY BY PAULA SPAN FOR NOV. 26, 2018. ALL OTHER USE PROHIBITED.
Editorial: Congress must act on Social Security’s solvency

That some workers are weighing early retirement and reduced benefits should bother members of Congress.

In this Sept. 2017, photo made with a drone, a young resident killer whale chases a chinook salmon in the Salish Sea near San Juan Island, Wash. The photo, made under a National Marine Fisheries Service (NMFS) permit, which gives researchers permission to approach the animals, was made in collaboration with NOAA Fisheries/Southwest Fisheries Science Center, SR3 Sealife Response, Rehabilitation, and Research and the Vancouver Aquarium's Coastal Ocean Research Institute. Endangered Puget Sound orcas that feed on chinook salmon face more competition from seals, sea lions and other killer whales than from commercial and recreational fishermen, a new study finds. (John Durban/NOAA Fisheries/Southwest Fisheries Science Center via AP)
Editorial: A loss for Northwest tribes, salmon and energy

The White House’s scuttling of the Columbia Basin pact returns uncertainty to salmon survival.

Goldberg: Mission not accomplished, but tensions have eased

The damage done to Iran’s nuclear capability isn’t clear, but its intention to build a bomb remains.

Where do I send my traffic ticket when I can’t renew my license?

I spent three hours this morning attempting to renew my driver’s license,… Continue reading

Comment: Your 6 cents will make sense to keep county moving

A 6-cent-a-gallon gas tax increase will fund road projects and maintenance and keep our economy strong.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.