While Connecticut struggles to deal with exponentially rising healthcare bills, a controversial bill aimed at capping upcharge fees has ignited a contentious battle among politicians. Governor Ned Lamont drafted the bill hoping to alleviate some of the weight of the medical costs on the patients, but some critics such as Senator Saud Anwar have warned that the bill could have unintended consequences.
The legislation, House Bill 6871, would cap what out-of-network physicians can bill patients, trying to address the cost burden of surprise medical bills. While the bill’s sponsors view it as a means of safeguarding patients from outrageous charges, Senator Anwar, a doctor and Public Health Committee chair, is worried about its long-term implications.
“This bill is a disaster,” Anwar said, citing its ability to destabilize the state’s healthcare system. He described how the legislation would lead to a loss of around $700 million for healthcare providers, putting serious financial pressure on hospitals, particularly those already struggling.
A Fragile Healthcare System
Anwar indicated that there are already several hospitals in Connecticut that are experiencing existential crises from financial instability. “Nine of our state’s hospitals are in danger of becoming insolvent,” he said, and that it would affect nearly half the state’s population. It is further compounded by Medicaid underfunding, which comprises a significant chunk of the state’s healthcare system’s income.
Medicaid reimbursement, Anwar said, is substantially less than it was in 2007. This shortfall has placed enormous strain on hospitals and doctors. “There is no other industry where you would be paid 57% of what you were paid 15 years earlier,” he said.
In addition, Anwar cautioned that the suggested changes would do further harm to the system, particularly in the face of possible reductions in Medicaid at the federal level. If federal funding is cut by $800 billion, as some estimates indicate, two of the state’s largest children’s hospitals may have to close. “That’s a disaster in itself,” he emphasized.
The Governor’s Perspective
Governor Lamont, though, views the bill as a step in the right direction to address surprise medical bills, especially when patients have no idea that a doctor or specialist is out-of-network. Such a situation usually leads to patients getting unexpected and outrageously high bills, even after undergoing treatment at an in-network facility.
In a hypothetical illustration, the governor described how a patient could be operated on in an in-network hospital, yet subsequently discover that the anesthesiologist was out-of-network, resulting in a much more expensive bill. Lamont aims to stem such surprise costs and shield patients from debilitating medical bills.
Although Anwar concurs that surprise billing is a serious problem, he does not think that the proposed bill is the answer. He noted that current federal and state legislation already deal with surprise medical bills, so the new proposal is unnecessary. “The government should not pick winners in this debate,” Anwar said, noting that the insurance industry will gain from the legislation while hospitals and healthcare providers continue to suffer.
Rather than maintaining the status quo, Anwar recommended a more comprehensive approach to health reform, one that emphasizes prevention and wellness. According to him, a shift from an illness-based system to a wellness-based system could lower healthcare costs in the long term. Spending on preventive care, he added, would not only be cost-saving but also enhance the overall wellness of the population.
The battle over healthcare reform in Connecticut is far from settled. Although the governor’s bill seeks to shield patients from surprise bills, critics such as Senator Anwar caution that it may have unintended consequences, such as the shutdown of struggling hospitals and additional burden on the state’s healthcare system. As lawmakers struggle with this matter, Anwar calls for more in-depth discussions regarding how to make healthcare more affordable and accessible to everyone.
As Connecticut continues down the path of healthcare reform, the debate is guaranteed to get hotter. The state leaders will have to meet the needs of patients, medical providers, and the insurance sector to devise a viable solution that can reduce the cost of care without undermining the health of the state’s healthcare system.