The Biden administration has issued a second interim final rule (IFR) to implement the No Surprises Act that takes effect in January. According to the American Medical Association (AMA) the move represents an undeserved gift to the insurance industry that will reduce health care options for patients. The AMA is urging the administration to delay implementation and allow full evaluation of policies in the interim final regulation that have negative long-term implications for patients and the health care system.
The IFR ”ignores congressional intent and flies in the face of the Biden Administration’s stated concerns about consolidation in the healthcare marketplace. It disregards the insurance industry’s role in creating the problem of surprise billing at the expense of independent physician practices whose ability to negotiate provider network contracts continues to erode,” said AMA President Gerald A. Harmon, M.D.
“Congress appreciated the negative consequences of national price setting for health care services and spent considerable time and effort developing a robust independent dispute resolution process to maintain market balance and preserve access to care, which the Administration apparently ignored,” Harmon added. “It also is apparent that the Administration failed to appreciate the importance of creating accessible and impartial dispute resolution processes as a backstop against even greater insurer abuses.”
This decision comes just days after the AMA published its annual edition of Competition in Health Insurance: A Comprehensive Study of U.S. Markets (PDF) with findings demonstrating the rise of highly concentrated markets for health insurance. This year’s study revealed that a startling 73% of the nation’s insurer markets can be classified as “highly concentrated,” according to the federal government’s own guidelines. The result is higher premiums and narrower provider networks, which are a root cause of the surprise medical billing problem.
The AMA urges the Biden administration to delay implementation and allow full evaluation of policies in the interim final regulation that have negative long-term implications for patients and the health care system.