As is often the case this time of year, we spent the last few weeks looking back on 2021, a year like no other. Many of our dreams of a return to normalcy were stymied and December was especially worrisome with the Omicron variant infecting us with a flood of new COVID-19 cases. I want to do an about-face and look forward to 2022. A wise farmer once said that you can’t plow a straight line when you are looking back over your shoulder. So, let’s forget about 2021, and 2020 for that matter, and look forward to 2022.
Our focus at Seniors Speak Out has always been alerting older Americans to the impact Washington’s proposed changes will have on our healthcare. The Build Back Better bill has the potential to have a huge impact, both good and bad, on our country’s healthcare in 2022 and our immediate focus needs to be on this huge piece of legislation. But first, let me talk about a law that has already been signed and took effect on the first day of this new year.
This new law focused on something you might have heard of – surprise billing. Surprise billing describes some ancillary portions of our healthcare costs that have caused many patients to be billed for costly out-of-network costs that they often had no knowledge of or control over. Insurance companies keep healthcare costs down by building a network of providers that contract to supply services at a set price. These providers are categorized as being “in-network.” If a patient chooses to go to an “out-of-network” provider, they are often charged much more. Surprise billing came about when patients weren’t properly notified when they were going out-of-network or informed of the out-of-pocket costs that could result. Some examples of these situations are emergency care at a hospital ER or urgent care center; elective care at an in-network hospital but where attending doctors, often anesthesiologists, pathologists, radiologists and assistant surgeons, are out-of-network; and air ambulances. Many patients have been “surprised” when these substantial charges appeared on their bills.
The new federal law bans many types of out-of-network medical bills, switching the responsibility to the providers and insurance companies to resolve their payment disputes. This new law is designed to limit the number of unexpected charges from providers that are not in the patient’s insurance network. As is often the case when the government steps in to regulate healthcare the results are not always positive, and the devil is always in the details. The new law stipulates that if the providers and insurance companies can’t resolve their differences then they must go to an arbitrator who will use the median in-network rate as a guide for the final cost. Many providers, including the American Hospital Association and American Medical Association, are suing the government, saying in-network rates shouldn’t be the guiding factor for the arbiter. We will keep you apprised on the success of the implementation of this new law.
Now, what is going on with the administration’s Build Back Better bill. As you probably already know, Senator Manchin (D-WV) decided he could not vote for the bill in its present form and, with the razor slim majority in the Senate, losing one Democratic vote would doom the bill’s passage. The bill is huge, costing anywhere from $1.7 to over $3 trillion, depending on how you price it, and it impacts many aspects of our life. From a healthcare perspective it has the potential to change some basics parts of our care. It would give the government the power to set prices on an ever-increasing number of prescription medications. While drug prices are a concern to all of us, this is not the right solution. Government inserting itself into the middle of a complicated and often convoluted supply chain pricing mechanism has the potential to produce a cornucopia of unattended consequences, with the most concerning one being the reduction in the research required to discover new cures. A positive part of this bill is the introduction of a yearly cap on out-of-pocket drug costs. This simple and easily implemented change is a long overdue enhancement that will reduce the anxiety we’ve all had with the threat of bankruptcy due to an illness that requires very costly medication.
The ever-increasing cost of drugs is a problem that must be dealt with. Drug manufacturers have continually voiced their desire to be part of the solution. Our government should take them at their word and sit down and work in good faith toward an answer. There’s the potential for huge savings in simplifying the supply chain pricing mechanism. The utilization of value-based contracts offers the chance to move from arbitrary pricing to a fact based, results-oriented system. Inserting government price fixing into a flawed pricing system will only cause more chaos with minimal positive impacts on the patient.
As you can tell, 2022 will start with some important decisions to be made. The new surprise billing law has the potential to impact our out-of-pocket costs. The Build Back Better bill has the potential to have both positive and negative impacts on our lives. Coupled with our continuing battle with the COVID-19 pandemic and the recent emergence of the Omicron variant we have our work cut out for us in staying current on changes to our healthcare and how to stay healthy. Seniors Speak Out will continue to keep you updated on what’s going on and give you the chance to speak out on how you feel about each proposed change to your healthcare. Looking forward to see where the rocks and gullies in our field are is the only way we can plow a straight line.