By Michael Pappas

When Gov. Phil Murphy announced the Garden State would waive fees for COVID-19 testing for nearly 2 million residents with certain health care plans, it offered both financial and emotional relief for many. It ensured that a large segment of New Jersey would avoid what many refer to as the surprise medical billing crisis. The governor’s announcement is certainly a step in the right direction, but anyone not receiving care through a federal program or a health insurance plan offered by the state or its public schools could still be left on the hook. Which raises the question: what can lawmakers do to protect the remainder of residents?

Congress has been at odds on how to address this unfair and inequitable process that has bankrupted low-income families. When someone with insurance gets ill and has no choice but to get treatment from an out-of-network provider in an emergency, the costs are often staggering. With some already receiving unexpected bills for coronavirus testing to the tune of thousands of dollars, it is a reminder that not only must Congress act, but it also must do so in the right way.

While some are pushing for an independent arbiter to sit down with providers and insurers to settle the out of network bills for patients, the same insurance companies that spend millions of dollars in lobbying want none of that. They seem to be using all of the influence they have in Washington to push a cost-fixing scheme on patients instead.

Unfortunately, some in Congress continue to carry water for these questionable at best interests with a mislabeled bill known as the Lower Health Care Costs Act (LHCCA).

The LHCCA would give insurance companies substantial say in the setting of healthcare prices. The bill would set the rate of all out-of-network coverage to the median in-network hospital rates for a given region. Insurance companies, of course, control the doctors on their networks. So, to reduce the median in-network rate, they would just have to drop the highest priced doctors from their health plans. While this move would provide them with significant cost-savings, it would also force even more New Jersey residents to lose their doctors. United Healthcare, the nation’s largest private insurer and one of its former members, has demonstrated time and time again how the insurers have turned kicking doctors off their networks into an art form. The LHCCA’s draconian incentives would give them even more reason to do so, but it would also exacerbate New Jersey’s doctor shortage at the worst possible time.

An aging workforce is already overwhelming the New Jersey healthcare system, while a third of the state’s doctors are approaching retirement. Replenishment from universities has failed to keep up with the demand, and even those who graduate largely avoid working in needy low-income areas.

Make no mistake about it: Senators Bob Menendez and Cory Booker must come to terms with a solution to this surprise medical billing crisis. Healthcare costs have already skyrocketed within the Garden State this year while the state struggles to deal with the second most coronavirus cases in the nation. Its residents need as much relief as they can get, especially in these trying times. That said, giving the insurance companies that have always been a part of the problem more power while jeopardizing the jobs of some of the most high-skilled doctors in New Jersey is certainly not the answer.

Rather than enacting a price-setting scheme for the insurers, Congress should consider implementing the arbitration model that has done wonders for New York since its enactment in 2015. Studies show that having the mediator work out pricing disputes between insurers and providers, rather than implement price-fixing schemes for insurers, has brought consumer complaints and costs down tremendously within the Big Apple. It can work here in New Jersey and elsewhere throughout the country if lawmakers give it a chance.

The last thing New Jersey residents needed during the height of this pandemic is even more unexpected healthcare bills to worry about. Here’s hoping our representatives rectify this surprise billing in a way that isn’t lined with cronyism.

Michael Pappas is a former Republican congressman for New Jersey’s 12th congressional district.

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