With competing Surprise Bill legislation currently being debated in Congress, the “No Surprises Act” is the one that is entirely untenable and short-sighted.  As drafted by Reps. Pallone and Greg Walden, it would set the out-of-network benchmark at 100% of the current median in-network rate for that geographic area.  The big employer groups (represented by outspoken ERISA Industry Committee EVP James Gelfand) are pushing hard for this bill for obvious reasons.  A bill such as this one, if enacted, would empower insurance companies to artificially limit networks in order to drive rates down.  Would this hurt providers?  Of course.  But the real unintended victim would be the patient population as a whole, which would be left with increasingly restrictive networks and limited access to specialists for emergent care.  Unfortunately, the lawmakers pushing this bill are not currently grasping this perverse, but entirely predictable, result of what is supposed to be a consumer protection bill.

Thankfully, there is a thoughtful group representing provider interests being led by Sherif Zaafran MD.  Called Physicians for Fair Coverage, they are providing data-driven points that push the discussion towards the type of IDR system that has worked so well in the State of New York.

I encourage every provider and healthcare attorney to visit the website for Dr. Zaafran’s group at https://www.endtheinsurancegap.org/ and sign up to show your support. 


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