Most legislation doesn’t work out like Congress says it will. This is especially true in health care, with the woefully misnamed Affordable Care Act being Exhibit A. A more recent stupidity was the No Surprises Act, intended to prevent consumers from getting big bills for out-of-network care. Out-of-network providers, mostly hospital systems, are out of network because they want to charge more and they do—their full outrageous billed charges that support grotesque overstaffing and bloated executive compensation. The law allowed these despicable providers to go after payers in an “independent” dispute resolution process. Basically the hospital systems are presenting the payers with these outrageous bills and then using this flawed process to force payment. And guess what, premiums are going up because of this and consumers pay even more.
Congress has finally taken notice of the effect of another of its misbegotten offspring and the Congressional Budget Office has issued a report noting that there may be a problem here. Really, may be? The CBO originally claimed the law would result in lower premiums. No one who understands how large hospital systems operate could possibly have thought that. CBO generally does reputable work, but their health care staff appear to be ill-informed, as the report at one point says it is hard to get information because health care claims lag care delivery by several years!! Not sure in what universe that occurs. Almost every state law and federal law require claims payment in 30 days and it is extremely rare for even complex claims to be unpaid or unresolved for more that a few months. Claims data is in fact available very, very quickly.
Anyway, CBO notes that providers appear to be gaming the system and are winning 80% of disputed bills and in the process running up far higher administrative costs. As anyone might have predicted, the end result of the whole scheme is to encourage providers to go out of network and get paid a lot more. We will see if Congress actually does anything or if the massive political contributions from the large health systems are more important to the politicians. You take a guess which it will be. (CBO Report)
