In my clinic, I see patients every day who are working hard to make ends meet but still can’t afford the health care they need. Many of them are uninsured or underinsured. They ration their medications. They skip follow-up appointments. They wait until their conditions worsen before seeking help because they simply can’t afford the cost of care.
Now, with federal cuts to Medicaid looming and enhanced Affordable Care Act premium tax credits set to expire, the situation is about to get worse. If Congress doesn’t act, millions of Americans could see their health insurance premiums skyrocket. That means more families in Louisiana and across the country will face impossible choices between paying the bills and getting medical care.
Congress should act immediately to extend these ACA tax credits so people can keep their coverage. But extending this financial help is only one part of the solution. To truly lower costs and fix our health system for the long term, lawmakers need to tackle the underlying reasons prices keep going up — including consolidation, unfair billing practices and lack of transparency — that allow big corporate health systems to game the system and drive up costs for everyone.
One of the biggest problems is how large hospital systems buy up small, independent physician practices and then charge patients more for the same services. By changing the logo on the door, these hospitals can suddenly bill Medicare — and patients — at much higher rates just because they now own the clinic. The quality of care doesn’t necessarily improve. The doctors, nurses and exam rooms are the same. The only difference is the price tag. As health care is becoming more expensive, patients are given fewer and fewer choices in where they can seek care.
That’s because Medicare reimburses services at a higher rate when they’re provided in hospital-owned outpatient departments than when the same care is delivered in independent practices. This practice is driving up health care costs across the country. Patients should be charged the same price for the same service, no matter where they receive it. Congress can fix this by passing site-neutral payment reform, a common-sense solution that has support from both parties.
Clarissa Hoff
Another hidden cost patients face is the “facility fee.” Many large hospital systems add these extra administrative charges on top of the cost of care, even for simple visits like blood pressure checks or vaccinations. These fees can be hundreds of dollars and often come as a surprise — they’re not tied to the actual care provided but to the administrative overhead of the hospital. For working families, that unexpected bill can mean the difference between staying in treatment or putting it off until it becomes an emergency.
Congress should prohibit these junk fees and protect patients from being charged more for fees unrelated to their care.
Finally, lawmakers should improve transparency by requiring each site of care to use unique national provider identifiers (NPIs). Right now, hospitals can bill using a single NPI for their entire system, hiding how much care — and cost — comes from their off-campus facilities versus inpatient ones. Requiring unique identifiers would help shine a light on what’s driving up prices and prevent people from being charged inpatient prices for outpatient care.
These reforms are bipartisan and practical. In fact, last Congress, the House passed the Lower Costs, More Transparency Act, which included site-neutral payment reform and a unique NPI requirement. Congress should build on that progress and get this across the finish line.
As a physician, I see what happens when people can’t afford the care they need. Preventable conditions become emergencies. Families go into debt. Lives are cut short. We can do better — and Congress has the tools to make it happen.
By extending ACA tax credits and passing bipartisan reforms to make pricing fairer and more transparent, lawmakers can deliver real relief to patients in Louisiana and across the nation. It’s time to start putting patients first.
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