Rep. Mike Gallagher
Rep. Mike Gallagher
By U.S. Rep. Mike Gallagher
R-Wisconsin

I grew up around healthcare. I’m the grandson, son, godson, nephew and brother of physicians who together have delivered over 20,000 babies in Wisconsin. As a result, I know firsthand that our state enjoys some of the best healthcare in the country.

This is why I was not surprised that former President Obama chose to deliver his first healthcare speech in my hometown of Green Bay in 2009. It was there he said: “Here in Green Bay, you get more quality out of fewer healthcare dollars than many other communities across this country. That’s something to be proud of.”

I didn’t often agree with him, but I agreed with that and I’m proud of our state’s record on healthcare.

In fact, Wisconsin continues to be a healthcare leader with only 5% of our state uninsured — tied for the fifth lowest rate in the country. While we work to bring that number down to zero, we also need to recognize that those who are covered face significant challenges in terms of cost and choice.

For example, middle-income families on employer-sponsored plans are spending as much as 11% of their income on out-of-pocket costs, while those on the private exchange on average have access to fewer than three insurers. Most people in Northeast Wisconsin are limited to just one insurer on the exchange. Limited access to coverage and higher out-of-pocket costs place a growing financial and physical burden on Wisconsin families.

We can do better. As President Reagan said in 1986, “No one in this country should be denied medical care for lack of funds.” Republican or Democrat, this is a statement both sides of the aisle should support. Unfortunately, as anyone who turned on the TV during the last election season surely knows, the healthcare conversation too often devolves into partisan, tribal warfare, with few real solutions being discussed.

The irony is that both sides have made the same mistake of focusing myopically on how we finance health insurance, while failing to focus on the underlying drivers of healthcare costs. After all, rising insurance premiums ultimately reflect the rising costs of healthcare. In America we spend nearly 18% of our GDP on healthcare while many similar industrialized economies spend closer to 10%. Until we find a way to control costs without compromising quality, we will not be able to sustainably finance health insurance.

The problem is our healthcare system is mind-numbingly complex. Complexity disadvantages patients, particularly when they are dealing with time-sensitive and life-threatening healthcare crises. The cure for complexity is transparency. Here’s where we can start:

Price Transparency: In the online economy, consumers can compare prices for nearly any product — except for healthcare. The Trump administration acted earlier this year to require hospitals to provide greater price transparency. This was a step in the right direction, but we have early evidence that hospitals are providing incomprehensible pricing data to check the box while scuttling the spirit of the regulation. That is why I introduced bipartisan legislation that would require healthcare providers — including hospitals, physicians, and health insurance companies — to tell you exactly how much their procedures, products, and services cost ahead of time.

In Wisconsin, we have already taken steps to provide consumers with better access to hospital pricing through Wisconsin Price Point. This program holds hospitals accountable to its patients and is a successful model other states should consider adopting, but more can be done. We also cannot overlook the costs employees bear to sponsor their employer coverage by disclosing how much employers take out of paychecks each month to pay for insurance. Greater transparency on the true cost of insurance will provide employees with a better sense of how healthcare costs can strain wages.

No Surprise Billing: Transparency at the point of sale is only one part of the equation. On a bipartisan basis, Congress is waking up to the burden placed on families by surprise medical bills, also known as balanced billing. These backdoor charges arise when patients are unexpectedly left to pay the difference between the cost of a medical service and the agreed in-network amount covered by insurance. If this sounds familiar, it should. Over half of American adults have received a surprise medical bill. In one recent story, a patient received emergency treatment at an in-network hospital but was left with a nearly $8,000 bill because his surgeon was out-of-network. This is unacceptable and we in Congress must demand better from the insurance companies and healthcare providers. We can and should create policies that protect patients from financial burdens that otherwise would not exist if they were provided with transparent and comprehensive information about their healthcare coverage and procedures.

Give Patients Data Control: Transparency in healthcare goes beyond prices and billing. Providing doctors with easier access to information such as electronic health records (EHRs) needs to be part of the solution. Test results, medications, and medical histories are just some of the critical information included in EHRs. When doctors have access to EHRs, they can reduce the chances for duplicative tests and provide physicians with a comprehensive picture of a patient’s health history. While the Centers for Medicare & Medicaid Services (CMS) recently proposed a rule that would provide patients with greater control of their EHRs, Congress is overdue to act. That is why I am working with my colleagues to introduce legislation that would improve access to healthcare records for providers. Timely access to a patient’s healthcare data will improve care coordination and can help keep healthcare costs down.

These are three small but meaningful steps Congress can take to get at the root cause of rising healthcare costs. At a time when bipartisan solutions seem hard to find, I am optimistic that transparency in healthcare is a common ground my colleagues on both sides of the aisle can support.

We expect transparency in our everyday lives. We should demand the same from our healthcare providers. Experimenting with how we provide transparency to patients can ultimately lead to improved outcomes, greater control of their healthcare and reduced costs. And that’s exactly what we all deserve.