Tags: heath insurers | surprise billing

Health Insurers' Surprise Billing Legislation Is a Trojan Horse

Health Insurers' Surprise Billing Legislation Is a Trojan Horse
Rep. Frank Pallone, D-N.J. (Getty Images)

By Tuesday, 01 December 2020 10:03 AM Current | Bio | Archive

The health insurance industry has reaped extraordinary profits as other industries continue to crumble through the pandemic, opening insurance companies up to accusations of profiteering and other aggressive business tactics that enabled them to pad their bottom lines.

But it appears that those profits just weren't enough. Now, as Congress prepares to conduct a session to complete unfinished business ranging from the federal budget to COVID aid, insurers and their lobbyist are pushing for legislation that would provide them the ability to pad their profits even further.

The legislation they are pressing for is a Trojan Horse. The industry says it would end the practice of so-called surprise medical billing, a situation involving a patient who receives emergency or non-emergency care at the hospital, only to find out after the hospital visit that one of the specialists who provided care was not covered in the patient's insurance network.

But far from ending the practice of surprise medical billing, the legislation sought by the industry merely pushes costs onto doctors at a time when medical providers across the country are on the front lines of the fight against COVID-19 and can least afford these kinds of cuts.

We have been here before with this brazen industry. Earlier this year, the insurance companies orchestrated a multi-million-dollar lobbying blitz on Washington in an attempt to persuade members of both parties to pass the legislation even though it represents a massive giveaway to the industry. For instance, America's Health Insurance Plans, which represents the bulk of U.S. health insurers, spent $3.6 million in the first quarter of this year on lobbying, a 28.5 percent increase over the $2.8 million the group spent in the same months in 2019, federal lobbying disclosure forms show.

Lawmakers rejected that push during the early and dark days of the pandemic, as doctors and other health care providers warned that the legislation would create burdens on them at a time when they were struggling to treat legions of individuals who had been infected with COVID-19.

Nevertheless, the industry nimbly pivoted from its legislative loss and found other ways to trim costs, including delaying authorizations and denying coverage during the pandemic. Besides, health insurance companies have been attempting to pare down physician networks available to patients in recent years in Texas, New Jersey, Massachusetts and Georgia – among other states.

Their strategy appeared to work — financially, at least. Consider that during the height of the pandemic, UnitedHealth, an insurance giant that has drawn scrutiny, posted its most profitable quarter ever.

Politically, however, there was a cost. Congress called for an investigation into the industry's massive profits, amid growing complaints about the hardball tactics that insurers engaged in with both doctors and patients.

"While the American people grapple with an unprecedented crisis, health and dental insurance companies appear to be making record profits as millions of people forego care and avoid doctors offices," according to a statement released by Rep. Frank Pallone, a New Jersey Democrat who chairs a House committee with jurisdiction over the health care industry.

But nothing appears to have come for this call to investigate the industry. If anything, the industry appears to be as emboldened as ever as it attempts to ensure that its legislation is high on Congress' priority list.

The industry has some powerful allies in Congress – including Representative Pallone, despite his call for an investigation of the industry. Indeed, he reportedly spent the early part of the year trying to shepherd through Congress the industry-backed legislation. And he is said to be pushing again.

It is unclear why Pallone has been pushing so aggressively for this legislation, though some critics point to the fact that he has been a recipient of significant campaign contributions from the industry over the years.

But what is clear is that Pallone's involvement means that doctors and consumers should be vigilant given his enormous clout and ability to deliver in the House.

A major concern is that the industry and its allies in Congress will attempt to slip the industry-backed proposal into the package of COVID-relief legislation that leaders in both parties hope to pass by year-end.

The industry's effort should not be taken lightly. The industry not only has powerful allies like Pallone in Congress. It also can spend millions of dollars deploying lobbyists throughout the capital — just as it did earlier this year during the height of the pandemic.

For the sake of a nation bracing for yet another wave of the pandemic, Congress needs to reject this unseemly power-grab and money-grab amid a national health crisis.

John Burnett is the Managing Director and Founder of 1 Empire Group consulting firm and a business executive with over 20 years of experience in the financial services and energy pricing industries. A veteran of politics, John is an official with the New York State Republican Party and ran for New York City Comptroller in 2013. An adjunct professor at Hampton University and New York University, John’s editorials on business, the economy, policy, and politics have appeared in HuffPost, U.S. News and World Report, and Washington Examiner. He is also a frequent guest commentator on Fox News, Fox Business News, New York 1, and PIX 11 News. John holds a B.S. with honors from New York University and an MBA from The Johnson School of Management at Cornell University. To read more of his reports — Click Here Now.

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The health insurance industry has reaped extraordinary profits as other industries continue to crumble through the pandemic, opening insurance companies up to accusations of profiteering and other aggressive business tactics that enabled them to pad their bottom lines.
heath insurers, surprise billing
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2020-03-01
Tuesday, 01 December 2020 10:03 AM
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