Dear Majority Leader McConnell and Democratic Leader Schumer:
The undersigned medical organizations remain committed to working with Congress to seek a balanced
legislative solution to protect patients from unanticipated (“surprise”) medical bills that can occur when
gaps in health insurance coverage lead them to receive care from out-of-network physicians or other
providers. We represent hundreds of thousands of practicing physicians who provide care to millions of
Americans every day in a variety of practice settings. We strongly believe that, in situations where a
coverage gap occurs and patients unknowingly or without a choice receive care from an out-of-network
physician or other provider, patients should be held harmless for any costs above their in-network cost sharing, and their cost-sharing should count toward deductibles and out-of-pocket maximums. Patients
should be completely removed from any subsequent payment disputes between their health insurance
company and an out-of-network provider when they experience an unanticipated coverage gap.
After ensuring that patients are protected, it is essential that any legislation does not create new
imbalances in the private health care marketplace. The health insurance market is already heavily
consolidated, which can result in artificially low payment rates and anticompetitive harms to both
consumers and providers of care. We are highly concerned that the rate-setting provisions in current bills
further shift marketplace leverage to health insurers at the expense of providers. As a consequence, this
imbalance will likely lead to access problems for patients seeking hospital-based care from on-call
specialists, as well as precipitate staffing shortages in rural areas and other underserved communities.
Furthermore, according to the Congressional Budget Office, “The vast majority of health care is delivered
inside patients’ networks, and more than 80 percent of the estimated budgetary effects of title I [of the
“Lower Health Care Costs Act” (S. 1895)] would arise from changes to in-network payment rates.” In
other words, in-network providers who have not contributed to the problem will bear the impact of the
rate-setting scheme. CBO reached the same conclusion in its analysis of Title IV of H.R. 2328, the “No
Surprises Act.”
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