Research by Yale economists Dr. Zack Cooper and Dr. Fiona Scott Morton is driving this burst of bipartisan legislating. The economists’ work exposed the scale of out-of-network billing in emergency departments, explained why it happens, and tested a potential policy solution. Their findings drew detailed coverage from The New York Times and other major media outlets and attracted the attention of state and federal lawmakers. Every congressional committee working on the issue has cited them. They have consulted with senators and members of Congress on policy remedies.
Dr. Cooper is associate professor of public health at the Yale School of Public Health and in the Department of Economics. They analyzed billing data from a large commercial insurer covering 2.2 million emergency room visits across the U.S. finding that more than one in five patients who went to emergency departments within their health-insurance networks were treated by an out-of-network doctor and potentially incurred substantial, unexpected expenses. It was the first national estimate of the frequency of “surprise” out-of-network medical billing.
The researchers calculated that patients were exposed to an average bill of $622.55 if their insurer only covered in-network rates. To address the problem, they proposed requiring hospitals to sell an emergency-care package that bundles physician services and facility fees, as well as staff their own emergency rooms and pay physicians directly — measures they argue would preserve competition among physicians, hospitals, and insurance carriers and ensure that patients are not surprised by expensive medical bills.