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OP-ED: Big Insurance Must Help End Surprise Medical Billing

NNPA NEWSWIRE — Known as “surprise medical billing,” these unexpected costs arise when a patient goes to a hospital for emergency or non-emergency care, only to find out afterwards that one of the medical providers who administered care was not covered in the patient’s insurance network.

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In the U.S. House of Representatives, Ways and Means Committee Chairman Richard Neal (D-Ma.) predicted that health insurers would do little more than look out for their own interest if they were given the authority to set rates for out-of-network providers. (Photo: iStockphoto / NNPA)

By Dr. Benjamin F. Chavis, Jr., National Newspaper Publishers Association President and CEO

It is a serious financial problem that far too many African Americans – from impoverished individuals to working-class families — face these days in the bewilderingly complicated health-care market: Getting hit with an unexpected bill after a hospital stay or visit to the emergency room.

Known as “surprise medical billing,” these unexpected costs arise when a patient goes to a hospital for emergency or non-emergency care, only to find out afterwards that one of the medical providers who administered care was not covered in the patient’s insurance network.

This outrageous situation benefits one group and one group alone: powerful insurance executives, who have managed to get off the financial hook for such bills, even as insurers shrink insurance coverage networks to wring more and more profits out of the system.

But this predatory practice is overwhelming to a family already dealing with the emotional and financial burdens of a medical crisis, typically adding thousands of dollars in unexpected expenses that can wipe out savings accounts or otherwise strain tight household budgets.

So, what can be done to stop and end surprise medical billing?

The good news is that both Republicans and Democrats in Congress agree that legislation is needed to protect patients against unexpected medical charges. But as with many complicated issues confronting Congress, lawmakers have been divided on the details of such legislation.

Part of the paralysis in Congress stems from confusion and disinformation, as insurance executives and their allies try to frame the debate to their advantage.

When Congress tried to address the issue last year, for example, the insurance lobbying machine swung into action, attempting to place the blame for surprise bills on out-of-network medical providers who end up having to charge patients when insurers refuse to cover a medical bill.

Big insurance almost got its way in that legislative debate when a handful of lawmakers threw support behind a legislative proposal that would shield insurance companies from paying what they ought to pay. The legislation, championed by Sen. Lamar Alexander (R-Tenn.), specifically called for setting benchmarked rates for out-of-network medical providers.

But far from solving the problem, this approach would make matters worse. It not only frees insurers from their responsibilities. It fails to compensate providers for the cost of the care that they actually provide. And that, in turn, means either patients will get stuck with the bill or medical providers will have to absorb big losses that ultimately jeopardize their ability to stay in business.

Fortunately, the proposed bill stalled after the medical community warned that the benchmarked rate favored by the insurance industry would allow insurers to exert a new troubling level of control over health-care prices and the larger health-care delivery system.

Now, as Congress begins to take up the issue once again, health insurance companies that evaded significant scrutiny last year seem to be drawing close scrutiny now, both inside and outside of Washington.

Speaking to a group of faith leaders and policymakers in South Carolina, an important stop for the 2020 Democratic presidential primary, Reverend Al Sharpton criticized the surprise medical billing legislation backed by insurers and stressed the urgent need to deal with the continued lack of access to adequate health insurance coverage for minority communities.

“Washington is getting it wrong,” he wrote in an opinion piece published after his South Carolina trip, adding that the bill introduced by “Sen. Lamar Alexander (R-Tenn.) to `solve’ the surprise billing problem would literally insulate insurance companies from covering these costs, at a time when profits for insurance companies have reached record highs.”

In the U.S. House of Representatives, Ways and Means Committee Chairman Richard Neal (D-Ma.) predicted that health insurers would do little more than look out for their own interest if they were given the authority to set rates for out-of-network providers.

“My concern with giving too much weight to such a benchmark rate is that we already know insurers are looking for any way they can to pay the least amount possible,” he said. “They will work to push those rates down, regardless of what it means for community providers like physicians, hospitals, and our constituents who they employ.”

There were similar concerns in the U.S. Senate, where Senator Bill Cassidy (R-La.) warned that insurers began gaming the system in California once benchmarking rates became the law of the land in that state in 2016.

“Insurance companies cancel contracts and then they have the negotiating power and they establish” their own rate, he said, adding that such benchmarking of rates would likely put hospitals “out of business.”

It’s worth noting that lawmakers are raising such concerns despite the considerable backing the insurance-industry legislation has had from two powerful lawmakers: Senator Alexander, chairman of the Senate Committee on Health, Education, Labor, and Pensions; and Frank Pallone, the chairman of the House Energy and Commerce Committee, whose jurisdiction includes health care issues.

More than that, Senator Cassidy introduced legislation that would eliminate surprise medical billing by establishing an arbitration system between insurers and providers — rather than sticking the disputed medical charges to patients. And that legislation is gaining strong bipartisan support, as is a similar bill in the House that is being advanced Representative Phil Roe (R-TN) and Representative Raul Ruiz (D-CA), both of whom are doctors.

Surprise medical billing is a problem we can no longer ignore, particularly at a time when roughly two-thirds of Americans say that they are concerned about their ability to pay for an unexpected medical expense for themselves or for a family member. And this practice it is especially hard on African Americans and other people of color in the U.S. who already face significant barriers to health care and who generally receive lower quality of care than the rest of the nation.

Congress has an opportunity to make things right by ending the practice of surprise medical billing. Black Americans and all others in America shouldn’t be saddled with exorbitant bills that they had no reason to expect – and that impose an unjust financial burden.

Dr. Benjamin F. Chavis, Jr. is President and CEO of the National Newspaper Publishers Association (NNPA) and can be reached at dr.bchavis@nnpa.org

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U.S. Business Leaders Step Up to Fight Inequities in the South

Even as the pandemic has laid bare societal inequities that have long eroded the foundation of our democracy, political leaders in Washington and in state capitols are mired in a level of rancor and partisanship not seen since the ideological struggles over the Vietnam War. 

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Dr. Benjamin F. Chavis Jr./ NNPA Newswire

Even as the pandemic has laid bare societal inequities that have long eroded the foundation of our democracy, political leaders in Washington and in state capitols are mired in a level of rancor and partisanship not seen since the ideological struggles over the Vietnam War. 

This toxic atmosphere has left them incapable of addressing pressing, yet ingrained issues like the racial wealth gap, the digital divide, and vast inequalities in everything from health care to home ownership.

With COVID-19 still an omnipresent concern and the country’s recovery still very much in jeopardy, individuals, families, and communities – particularly communities of color throughout the South – are struggling to deal with issues that have only been exacerbated by the pandemic.

From impediments to wealth creation opportunities and a dearth of education and workforce development to a lack of access to reliable broadband, substandard housing, and inadequate political representation, communities of color have suffered an outsized toll during the ongoing public health crisis.

Yet political leaders can’t even agree on basic facts that would allow the nation to implement a coherent national strategy for combatting a pandemic that appears to be entering a new wave amid the rise of the highly contagious Delta variant that is currently ravaging parts of the South.

Against that disillusioning backdrop, there is at least some reason for hope. Moving to fill the vacuum created by the inaction of our political class, a group of business leaders in the technology and investment sectors have embarked on a far-reaching – and perhaps unprecedented – campaign to address the social inequities and systemic racism that has historically plagued our country’s southern communities.

Known as the Southern Communities Initiative (SCI), the campaign was founded by financial technology company PayPal, the investment firm Vista Equity Partners (Vista), and the Boston Consulting Group (BCG).

SCI was formed to work with local elected officials and advocacy groups to tackle the ubiquitous problems of structural racism and inequalities facing communities of color in six communities throughout the South. SCI notes that these areas – Atlanta, Ga., Birmingham, Ala., Charlotte, N.C., Houston, Texas, Memphis, Tenn., and New Orleans, La., – were chosen in part because they are home to around 50% of the country’s Black population and are where some of the greatest disparities exist.

SCI is aiming to drive long-term change, as outlined by PayPal CEO Dan Schulman, Vista CEO Robert F. Smith and BCG CEO Rich Lesser. 

In Atlanta, for example, SCI is working to bridge the wealth gap that exists among the region’s African-American residents. While there is a strong Black business community in the city, and high levels of Black educational achievement thanks to the regional presence of several Historically Black Colleges and Universities (HBCU) and the voice of the Black press, there is still an extremely low level of Black entrepreneurship and business ownership with only 6% of employer firms being Black-owned.

To remedy this disparity, SCI is working with the Southern Economic Advancement Project to create entrepreneurship hubs and accelerator programs to increase the number of minority-owned businesses. The corporations behind SCI are also using their networks to help other companies work with minority-owned supply companies.

In Alabama, SCI is seeking to bridge the massive digital divide in an urban area where 450,000 households are without connection to the internet. In order to tackle the crisis, SCI is leveraging relationships with local schools and libraries to distribute laptops and service vouchers. Another tact SCI is taking is to partner with the owners of multi-unit buildings in low-income neighborhoods to install free public Wi-Fi for residents.

The lack of access to capital is another reason Black communities throughout the South have been traditionally underbanked. In Memphis, where 47% of Black households are underbanked, SCI is partnering with Grameen America to cover the $2 million per year per branch start-up cost to build brick-and-mortar banks in minority communities.

This alone will provide 20,000 women access to more than $250 million per year in financing.

Beyond these initiatives, SCI is partnering with groups like the Greater Houston Partnership and the Urban League of Louisiana to provide in-kind support to improve job outcomes for minority college students, expand access to home financing through partnerships with community development financial institutions, and harness the power of technology to expand health care access in underserved urban and rural neighborhoods.

The issues facing these communities throughout the South are not new nor will they be fixed overnight.

Fortunately, SCI is taking a long-term approach that is focused on getting to the root of structural racism in the United States and creating a more just and equitable country for every American.

A once-in-a-century pandemic and a social justice movement not seen since the 1960s were not enough to break the malaise and rancorous partisanship in Washington. Fortunately, corporate leaders are stepping up and partnering with local advocates and non-profit groups to fix the problem of systemic injustice in the U.S.

We, therefore, salute and welcome the transformative commitments of the Southern Communities Initiative (SCI). There is no time to delay, because as Dr. Martin Luther King Jr. so accurately said, “The time is always right to do what is right.”

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NNPA – Black Press w/ Hendriks Video Interview

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Black Woman to Lead United States Park Police

 Chief Smith’s experience serving in leadership roles in every U.S. Park Police field office has provided her with an unmatched foundation to lead the diverse agency,” said Flynn, who oversees law enforcement programs at USPP.

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Pamela A. Smith

Pamela A. Smith, a 23-year veteran of the United States Park Police, will lead the nation’s oldest federal law enforcement agency.

Smith, who became the first African American woman to lead the 230-year-old agency, immediately remarked that she would establish a body-worn camera program for USPP within 90 days.

The program will initially begin in San Francisco and be implemented across the country by the end of the year, Smith said.

“Body-worn cameras are good for the public and good for our officers, which is why I am prioritizing implementing a body-worn camera program within my first 90 days,” Smith offered in a statement.

 “This is one of the many steps we must take to continue to build trust and credibility with the public we have been entrusted to serve.”

Smith earned a bachelor’s degree in Education from the University of Arkansas at Pine Bluff and graduated from the FBI National Academy. She is a member of the National Organization of Black Law Enforcement Executives and the International Association of Chiefs of Police.

During her law enforcement career, the proud Zeta Phi Beta Sorority sister has served as a patrol officer, field training officer, canine handler, and academy instructor at the Federal Law Enforcement Training Center.

 According to a news release, Smith also served as executive lieutenant to the chief of police, assistant commander of the San Francisco Field Office, commander of the New York Field Office, acting deputy chief of the Homeland Security Division, and deputy chief for the Field Operations Division.

Smith was the first woman to lead the New York Field Office as its Major.

At the USPP, she will lead a 560-member workforce that protects the public, parks, and the nation’s most iconic landmarks in Wash., D.C., New York City, and San Francisco metropolitan areas.

“Chief Smith’s commitment to policing as public service and her willingness to listen and collaborate make her the right person to lead the U.S. Park Police at this pivotal moment in our country,” Shawn Benge, deputy director exercising the delegated authority of the NPS director, noted in a statement.

 “Over the coming months, the leadership of the National Park Service will explore opportunities with Chief Smith designed to strengthen our organization’s commitment to transparency. Her personal and professional experience make her acutely aware of and ready to meet the challenges and responsibilities that face U.S. Park Police and law enforcement agencies across the nation.”

 Jennifer Flynn, the associate director for Visitor Resource Protection at the National Park Service added that she’s looking forward to Smith’s leadership.

“Chief Smith’s experience serving in leadership roles in every U.S. Park Police field office has provided her with an unmatched foundation to lead the diverse agency,” said Flynn, who oversees law enforcement programs at USPP.

 “As federal law enforcement officers, the U.S. Park Police officers have a new opportunity each day to give their best to the American people. Chief Smith exemplifies that approach as a colleague and mentor, and she will be instrumental in refining and shaping the future of the organization,” Flynn said.

Smith declared that she would lead by example and expects all officers to display integrity.

 “I have dedicated my career to the professionalism of law enforcement, and it is my highest honor and privilege to serve as chief of police,” Chief Smith declared. “Today’s officers face many challenges, and I firmly believe challenges present opportunities. I look forward to leading this exemplary team as we carry out our mission with honesty and integrity.”  

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