While the No Surprises Act has saved Americans from huge surprise bills, the law is fundamentally flawed and needs to be reformed.
About The Podcast:
Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.
Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.
Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.
Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.
Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.
Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.
About The Episode:
On this episode, Marc discusses the No Surprises Act. It has saved Americans from huge surprise bills, but the law is fundamentally flawed and needs to be reformed.
Key Takeaways:
The No Surprises Act has saved millions of Americans from huge surprise bills.
The Blue Cross Blue Shield Association projected in early 2024 that the NSA averted 10 million surprise bills in the first nine months of 2023 alone.
Another study finds that there was a $567 decrease in out-of-pocket (OOP) spending related to surprise billing for people living in states that did not have protections before the national law.
The study finds that the NSA appears to be generating more savings to Americans than other coverage measures or cost reductions and protections.
But the baseball-style arbitration process in the law is heavily stacked against health plans and favors providers.
In baseball-style arbitration, an arbiter decides between one or the other last best offers from the sides and cannot craft a middle ground.
A new study by Georgetown University researchers and published in Health Affairs, show that providers have won 85% of disputes since the fourth quarter of 2023.
In these cases, the median payments were three to four times higher than average median in-network rates.
There has been over $5 billion in total costs through the end of 2024 due to the law. Additional payments were about $2.24 billion, with additional administrative costs and fees totaling $2.78 billion. Annually, this totals $2 to $2.5 billion a year in increased costs.
The study also finds that the majority of the disputes are filed by a small number of providers that are backed by private equity firms.
At least three major insurers have now sued various providers over their abuse of the dispute resolution process.
The bill has and will continue to increase costs in the healthcare marketplace.
Reform is absolutely needed.
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Resources:
The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
