WHA Urges Senator Baldwin and Wisconsin Congressional Delegation to Remove Benchmark Rates from Surprise Billing Legislation

June 25, 2019

With the Senate’s Health, Education, Labor, and Pensions (HELP) Committee set to take up health care transparency and surprise billing legislation later this week, WHA once again urged Wisconsin lawmakers to preserve free market health care options.

In a letter to Senator Tammy Baldwin, who sits on the Senate HELP Committee, WHA reiterated its support for Congress’ efforts to improve transparency and reduce instances of surprise billing. However, it noted the very serious concerns from the health care community that resolving billing disputes by using a median in-network rate as a benchmark could have unintended consequences that undermine the free market and reduce provider choices for consumers.

“This seems to be tilted heavily in favor of insurers,” noted Eric Borgerding, WHA President and CEO. “Why would an insurer contract with a provider that requires a rate above the median rate if the insurer knows it can pay less if it does not contract with that provider?” WHA also shared these concerns with the rest of the Wisconsin delegation.

WHA also noted that surprise billing appears to be less of an issue in Wisconsin due to its high level of integration. According to an analysis WHA requested from the Office of the Commissioner of Insurance (OCI), only 61 surprise billing complaints were received in a 15-month period from 2018 to 2019, with five insurers accounting for the bulk of those complaints. Data from the Health Care Cost Institute also found that Wisconsin compared favorably to other states, with only 4% of hospital admissions resulting in an out-of-network surprise bill, compared to 20-26% of admissions in states like Texas, Florida, and California.

WHA also noted there can be significant variation in health care markets across the state and country, and that one-size-fits-all solutions like the one being proposed can often trade one problem for another. It urged lawmakers to continue exploring other mechanisms to resolve balance billing disputes that would not have the same detrimental impacts.

The Senate HELP committee is expected to take up this legislation on June 26. WHA will continue to actively engage lawmakers in the Senate and House as the legislation progresses, as well as examine these issues in its Transparency Task Force meeting later this week.

WHA urges members to contact their elected officials to express their concerns with the legislation currently being developed.

This story originally appeared in the June 25, 2019 edition of WHA Newsletter