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Chairman Smith Opening Statement – Hearing on Reduced Care for Patients: Fallout from Flawed Implementation of Surprise Medical Billing Protections

September 19, 2023

As prepared for delivery.

“Three years ago, Congress passed the bipartisan No Surprises Act to end surprise medical bills for good. American patients were in desperate need of these protections as too many had come face to face with medical bills from being treated without their knowledge by an out-of-network doctor. It left them on the hook for tens and even hundreds of thousands of dollars in surprise medical expenses.

“This law has seen success in ending that crisis. Unfortunately, the new surprises for patients have come in the form of medical staff shortages, longer wait times, and fewer choices because of the federal government’s flawed implementation of the law.

“Three years ago the Ways and Means Committee led the bipartisan effort to draft the No Surprises Act, but agency rulemaking has unfortunately ignored congressional intent. It has created a tilted dispute resolution process that has left medical providers paying more to participate in a process that often forces them to accept artificially low payments with no enforcement guarantee. It has also led to legal challenges that have resulted in significant backlogs and left the process clouded in uncertainty.

“This law’s implementation has made the very problem it intended to fix worse, resulting in more medical providers no longer covered under health insurance networks. This leaves Americans paying more to access fewer doctors than ever before.

“All of this makes it harder for patients to access quality care as health care facilities struggle to even keep their doors open, particularly in rural areas. Consequently, emergency room wait times have doubled since 2020. The rules implementing the No Surprises Act have inflamed an existing staff shortage in an industry where having too few people can be a life and death matter. Right now, 600 rural hospitals are at risk of shutting down.

“Left unchanged, these federal rules will continue to lead to less access to quality care.

“Patients are the ones most impacted by closed hospitals and long wait times for critical services. Rural and urban areas both face a health care shortage.

“At the same time, the agencies have not been bothered to implement the “advanced explanation of benefits,” one of the key reforms that members of this committee fought to include in the No Surprises Act. Part of ending surprise billing is ensuring that people know the price of health care services – before they walk in the door.

“Before a patient sees their doctor, patients should be told how much they’ll pay for the care they receive. And yet, patients still have yet to benefit from this protection to which they are legally entitled.

“While Congress made strides in stopping surprise medical bills, the fallout of this law’s implementation demands our oversight, and I’m encouraged that there is interest from both parties in seeing this bipartisan law fairly implemented. It’s unacceptable that a major win for Americans be turned into a scenario where medical providers struggle to keep their doors open, patients lose access to quality care, and the basic principle of knowing the price of the care they’ll receive has yet to be realized. I look forward to working with my colleagues on both sides of the aisle to make the promise of the No Surprises Act a reality.”