Rev. Sharpton’s Letter to the Congressional Black Caucus Concerning Unaddressed Healthcare Issues—
March 23, 2020
Dear Chairwoman Bass, Congresswoman Kelly, and Congressman Butterfield,
Thank you for the meeting last week to discuss the impact of surprise medical billing on our communities of color. I commend you and your colleagues in the Congressional Black Caucus for working to remove patients from the middle of billing disputes between insurers and providers as part of surprise medical billing legislation. Given the recent trend towards “narrow networks,” the legislation should focus on stopping these surprise bills. When Americans receive life-saving medical care, only then to have their insurance company refuse to cover the service, it can be financially and emotionally devastating. Finding a way to prevent this behavior, while preserving access to critical health care services in the black community is a noble endeavor. I fully support your efforts and stand prepared to help find a solution that protects Black Americans’ hard-earned progress on access to affordable care. In the midst of the COVID-19 crisis, it is more important than ever to support hospitals, doctors, nurses and first responders and understand that they are on the frontlines every day – especially today.
I am pleased to see that all of the proposals coming out of the House Committees will remove the patient from the middle of billing disputes. The National Action Network favors those that seek to preserve equitable negotiations through an arbitration process. This third party arbitration mechanism is currently the most effective way to ensure neither side is able to game the system for their own benefit. At the same time, our organization has been deeply disappointed that the proposals from the House Energy & Commerce Committee and the Education & Labor Committee seem to take the opposite approach by heavily tilting the playing field in favor of insurers. These proposals are guided by the flawed view that insurers will lower premiums while maintaining coverage of care. But unfortunately, history has shown that the insurers will cover what is legally required of them and nothing more. It has also shown that no matter how deeply cuts are made to reimbursement for physicians, nurses, first responders and hospitals, the insurers will not dip into their profits to lower premiums.
Furthermore, undermining our already strained hospitals, doctors, nurses and first responders during a global pandemic is not only unthinkable, but unconscionable and downright irresponsible. Each of these American workers are standing on the front lines of the fight against COVID-19. Many hospitals and providers were already under considerable strain due to efforts to slow health care expenditures. These existing economic pressures have had a particularly dramatic effect on rural communities and in communities of color. More than 125 rural hospitals have closed since 2010 and there are more to come. Even under normal circumstances, it would be unwise to propose making such devastating cuts to providers in rural and minority communities. In the wake of the COVID-19 pandemic, proceeding with this ill-advised approach is needlessly dangerous. The Energy & Commerce Committee proposal would also have an acutely negative impact on hospitals that disproportionately rely on Medicaid and Medicare funding, including many in rural America and our inner cities, that are about to become overcrowded and understaffed as we combat a global pandemic. When cuts are made to health care services, the communities that get hit first and hardest are the minority, rural and underserved communities where we are already seeing hospital closures. The CBC must act swiftly to protect these vulnerable communities.
Once again, I ask that the CBC continue being a voice for the voiceless and ensure that insurance companies do not increase premiums on the American people if they do not get their preferred legislation. Rather than giving a gift-wrapped handout to the insurers, Democrats and the CBC should be holding insurers accountable by requiring them to cover the services patients pay for with their ever-increasing premiums. The historic accomplishments of the Affordable Care Act should not be dispatched with just so the insurers can turn around and provide increasingly narrower in-network options that do not cover the basic health care needs of Black Americans.
Democrats, and especially the members of the CBC, have spent decades fighting for affordable health care coverage for all Americans. These fights have always pitted us against powerful forces, particularly in the health insurance industry, who are driven by profits derived from higher premiums and less available care. When it comes to surprise medical bills and insurance denials, Democrats should demand insurers, with their record profits, pay their fair share – not just the providers. Some of the current proposals in the House do nothing to require insurers to provide the health care coverage that the average Black American needs to improve the health outcomes in our communities.
Forcing providers to accept median in-network rates for out-of-network services only strengthens the insurers’ ability to manipulate our health care system to the detriment of patients. These proposals reward the very companies that are undermining the promises of the Affordable Care Act by constantly narrowing provider networks and the scope of covered medical services. The current trend in the private health insurance market is for insurers to provide “skinny” plans. This is a euphemism for providing less care and enjoying greater profits. In part, based on these new plans that leave the patient without the proper access to affordable care they have been promised, publicly-traded insurers boasted a 66 percent increase in profits last year.
Any surprise medical billing legislation, particularly one written and passed by a Democratic House of Representatives, should require network adequacy. Insurers must negotiate in-network agreements with providers for all the services black and underserved communities require. The CBC must stop the trend towards “skinny” plans and narrow networks that take advantage of consumer’s optimism about their health to sell plans that do not provide the coverage needed during a health emergency.
To the extent insurers refuse to negotiate in-network agreements that benefit patients, the CBC and Democrats should support legislation that caps out-of-pocket costs for emergency care and related services. This would protect patients from being held responsible for medical bills that insurers refuse to pay. It would also incentivize insurers to negotiate in-network agreements so that they are not left responsible for the patient’s out-of-network share of the medical bills.
In conclusion, I am grateful for the difficult work being done by congressional leaders to remove patients from the middle of surprise medical denials. The Congressional Black Caucus should maintain their leadership on these issues. I urge you to support legislation that removes the patient from the middle; requires insurance companies to provide robust in-network options that meet the needs of patients includes a robust independent dispute resolution process without arbitrary limitations; and cap patients’ out-of-pocket costs for emergency care and related services.
I look forward to working with the CBC on this critically important issue. I stand ready to defend the progress we have made on behalf of communities of color through the Affordable Care Act. Congress has the opportunity to do the same and address surprise medical bills with thoughtful legislation that rectifies the health disparities that insurers have been allowed to foster.
Reverend Al Sharpton