Some observers have speculated that the law will have the unintended consequence of shifting costs and leading to higher insurance premiums. But many policy experts told KHN that, in fact, the opposite may happen: It may slightly slow premium growth.
The reason, said Katie Keith, a research faculty member at the Center on Health Insurance Reforms at Georgetown University, is that a new rule released Sept. 30 by the Biden administration appears to “put a thumb on the scale” to discourage settlements at amounts higher than most insurers generally pay for in-network care.
That rule, which provides more details on the way such out of network disputes will be settled under the No Surprises Act, drew immediate opposition from hospital and physician groups. The American Medical Association called it “an undeserved gift to the insurance industry,” while the American College of Radiology said it “does not reflect real-world payment rates” and warned that relying on it so heavily “will cause large imaging cuts and reduce patient access to care.”
In early December, the AMA, joined by the American Hospital Association, filed a lawsuit challenging a part of that rule that outlines the factors that arbitrators should consider in determining payment amounts for disputed out-of-network bills. The case does not seek to halt the entire law, but does want changes to that provision, which it says unfairly benefits insurers. Later in the month, groups representing emergency physicians, radiologists and anesthesiologists filed a similar lawsuit.
Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction