Addressing the Root of Surprise Bills for Texans

Recently there has been much attention in the media and at the Texas Capitol placed on surprise bills for Texas consumers. One bill aimed at addressing surprise billing, Senate Bill 507 by Senator Kelly Hancock, is a step in the right direction for consumers to have an option for recourse against large medical bills.

However, expanding mediation efforts does not address the root of the problem, which is why we must supplement Senator Hancock’s efforts by taking aim at a new target. The “surprise” associated with medical bills stems from surprise coverage – when a patient is woefully underinsured and pays a larger out-of-pocket expense than anticipated for medical care.

Data from the Bureau of Labor Statistics and Kaiser / Health Research Education Trust Survey of Employer-Sponsored Health Benefits shows that since 2011, health insurance deductibles have increased 63 percent and premiums have increased by 19 percent, while workers’ earnings increased only 11 percent. This means that a patient’s financial responsibility for medical care has significantly increased. Put another way, Americans may be spending more on health insurance that covers less.

Additionally, payments made by health insurance companies are significantly less than what enrollees are paying for coverage. Peterson-Kaiser Health System Tracker reports that since 2004, consumers are spending 256 percent more on health insurance deductibles and 107 percent more on coinsurance. In that same timeframe, payments by insurance increased at just 58 percent.

This indicates that insurance companies have successfully shifted a significant portion of healthcare costs to patients. Towers Watson / NBGH Employer Survey data shows that healthcare costs to insurance companies are trending downward, and in 2013 reached their lowest rate in 15 years.

Shifting a portion of the cost of healthcare to consumers is how insurance companies like United Health reported record profits in 2015, and then again in 2016. Or how Aetna achieved record operating revenue in 2015. When insurance companies charge more for coverage while paying less to enrollees, their profits skyrocket.

Investors have also taken notice of these trends – more Americans enrolled in health insurance, rising deductibles, shifting costs to consumers – and poured in money to health insurance company stocks, causing them to jump significantly following the passage of the Affordable Care Act.

If the goal is to protect consumers from crippling healthcare bills, then we should focus efforts to end the insurance gap. With the proliferation of high deductible plans, more and more patients are realizing that their surprise bill is actually a product of surprise coverage. It would not be unusual for patients today to pay thousands of dollars more out-of-pocket than they would have just five years ago.

Unfortunately, many patients do not understand their own lack of coverage until a medical emergency has occurred and they are on the hook for thousands of dollars in medical care expenses. Why should consumers pay large amounts in monthly premiums to insurance companies, only to realize they don’t have coverage when they need it most?

We must carefully consider the impact of high deductible plans and insurance cost shifting to develop a practical solution that protects consumers; otherwise surprise coverage will become more rampant and consumers will continue to be distraught by their increasing financial responsibilities for health insurance.

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