Physicians For Fair Coverage

Ahead of Senate HELP Markup, Physicians Join Experts in Warning of Patient Impact Under Benchmarking System

Thursday, 06/27/19

Physicians for Fair Coverage (PFC), a non-profit, non-partisan alliance of tens of thousands of physicians, issued the below statement ahead of the Senate HELP Committee’s markup of the Lower Health Care Costs Act:

“We know that government-imposed national rate-setting will lead to narrower insurance networks, the termination of long-standing contracts between physicians and insurers, and patients’ restricted access to quality care from the doctors they trust. California’s surprise billing law, which imposes a similar government rate-setting scheme, has put insurers in the driver seat on health care. Whether it’s compounding the doctor shortage or threatening rural hospitals’ ability to keep their doors open, we know this legislation will have a devastating effect on our health care system because our worst fears are being realized in California. One size does not fit all — we’ve seen that approach fail before, and there is no question that it will fail again,” said Dr. Sherif Zaafran, Chair of Physicians for Fair Coverage.

“The Senate should adopt the Cassidy-Bennet bipartisan, compromise framework that has 24 cosponsors and includes an Independent Dispute Resolution (IDR) process. This is the framework used in nearly a dozen states, including Texas, New York, and Washington, and it is the only solution proven to end surprise billing without having a crippling impact on provider networks,” continued Dr. Zaafran. “Instead of allowing the government to pick winners and losers and significantly inhibiting physicians’ ability to increase overall quality while decreasing costs, we urge Congress to level the playing field for all stakeholders with a common-sense compromise that works.”

According to a case study on the New York model from the Georgetown University’s Center on Health Insurance Reforms, IDR resulted in a 34 percent drop in out-of-network billing, and there is no evidence the law had resulted in higher costs. “Indeed, one study found a 13 percent average reduction in physician payments since the law was enacted. State regulators report that there has not yet been an indication of an inflationary effect in insurers’ annual premium rate filings,” according to the case study.


Each year, millions of Americans seek emergency care at a hospital, and they do their best to ensure they receive care from in-network hospitals and providers covered by their health insurance plan. However, even if patients receive care at an in-network hospital, they could be treated by an out-of-network physician, which may result in what is commonly referred to as a surprise or balance medical bill.