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Rep. Luján has Rx for those surprise medical bills

Access to quality and affordable health care is at risk in rural communities across the country. With nearly 700,000 people living in rural areas in New Mexico, according to the U.S. Department of Agriculture Economic Research Service, it’s imperative that the state’s leaders take rural health care access seriously. Rural hospital closures have left one-quarter of rural Americans without access to care when they need it, according to research by the Harvard School of Public Health. Air medical services have stepped up to fill the gap left by hospital closures, but this industry is also being threatened.

As Congress works on proposals to prevent Americans from receiving surprise medical bills – an important area of focus so that no patient receives a bill they didn’t expect or cannot afford – it’s critical that policymakers also look at the root cause of these health care costs, while preserving access for patients.

Rep. Ben Ray Luján, D-N.M., understands this and has offered a provision to the House Energy and Commerce Committee’s No Surprises Act (HR 3630) to ensure we have an accurate – and transparent – picture of the costs of health care services – particularly when it comes to emergency air medical services.

Why is this so important?

Collecting data on air medical industry pricing would allow Congress to assess the rate of surprise billing, as well as ensure these services have the financial support to continue providing care. As the need for air medical services has gone up, government reimbursement rates haven’t been updated to meet today’s true cost of care, leaving air ambulances struggling financially. Seventy percent of air medical patients are covered by Medicare, Medicaid or have no insurance, meaning most air medical transports are reimbursed at an increasingly low rate. This then results in cost-shifting and, while private insurers could readily cover these services, some refuse to go in-network with air medical companies or arbitrarily deny coverage after the fact, putting patients in the middle of balance bills. (Balance billing is the practice of a health care provider billing a patient for the difference between what the patient’s health insurance chooses to reimburse and what the provider chooses to charge.)

In order to address the issue of balance billing for air medical services, two things must happen. First, legislation should target the predatory practices of bad actors in the insurance industry who either deny coverage based on “medical necessity” or refuse to go in network with providers. Second, policymakers should collect data that will both provide an accurate picture of the costs associated with providing air medical services and dispel some of the inaccuracies surrounding the rates of surprise billing in the industry. In fact, recent data from the Wyoming Department of Public Health show most air medical transport patients pay little or nothing for these life-saving services. Ensuring Congress has access to national-level data of this nature means it will be able to have more clarity on how to solve this issue once and for all.

Congressman Luján’s amendment would require the Department of Health and Human Services and the Government Accountability Office to collect cost data from air medical providers and claims data from insurers, and report the overall cost of these services to Congress. This amendment necessitates full data transparency, particularly from insurance companies, and will help inform sound policies that take patients out of the middle of balance bills.

The Senate Committee on Health, Education, Labor and Pensions should also adopt the language in the Luján amendment as it considers the Lower Health Care Costs Act to provide a more comprehensive solution to surprise bills. While the bill is well-intentioned, Section 105 would allow insurers to pay only the “median in-network rate” to air medical providers. Under this provision, insurers could pay even lower rates to air medical companies, which threatens access to air medical services for millions of patients across the country. It also fails to hold insurers accountable for predatory practices like arbitrary denials of coverage, which can lead to surprise bills.

Thanks to Rep. Luján’s leadership, we are one step closer to a federal solution that takes a comprehensive approach to tackling surprise bills, without threatening access to emergency care for millions of Americans, especially those in rural or underserved areas. Members of Congress should take note and ensure they’re working toward viable solutions that prioritize American lives over insurance industry profits.

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