Matt Fiedler

That, ultimately, is the main tradeoff actually presented by this lawsuit and this debate more broadly. Should prices be higher, benefitting providers, or should prices be lower, benefiting consumers? /end

On the other hand, blocking the CMS rules as the AHA/AMA want would likely harm consumers in another way: namely, consumers’ premiums would rise to finance the higher prices providers would then receive.

The rest is services where patients don’t select their providers and hospitals control staffing (e.g., anesthesiologists). There’s every reason to believe hospitals will do what they need to to ensure adequate coverage, whether from in- or out-of-network providers.

If the concern is access, remember that much of what we’re talking about is emergency care, where federal law bars providers from turning away out-of-network patients.

Problem #2: Even if network participation did fall, this would not harm patients as the AHA/AMA claim it would. If higher patient cost-sharing is the concern, remember that the *whole point* of the law is that patients will owe only in-network cost-sharing regardless.

By anchoring arbitration outcomes to the QPA, the CMS rules will make arbitration outcome more predictable, making it more likely the parties will have shared expectations of how arbitration will go.

If anything, the CMS rules seem likely to *reduce* reliance on arbitration, especially in the near term. Parties will typically end up in arbitration only if they disagree on the likely outcome of arbitration. (Otherwise, per the logic above, they’d cut a deal.)

Put another way, relying on arbitration amounts to a mutual agreement to set money on fire. There’s no reason to expect many providers and insurers to want do that, at least over the long term, no matter what the arbitration rules are.

And it will be in *both* parties’ interest to do exactly that. Relying on arbitration creates administrative costs for both parties. Thus, agreeing on a contracted rate close to the expected arbitration outcome is better for both parties than arbitration.

This argument supposes that providers and insurers have only two options: (a) keep their current contracts; or (b) rely on arbitration. In reality, providers and insurers can negotiate *new* contracts.

The AHA and AMA believe, likely correctly, that the CMS rule will reduce the prices that emerge from arbitration. But, from there, the AHA/AMA reasoning runs into two big problems.

The new No Surprises Act lawsuit from the AHA and AMA argues that CMS’ rules implementing the law will reduce network participation and thereby harm patients. A thread on why that’s unlikely (and why, in fact, I’d bet on the opposite).https://twitter.com/UpshotNYT/status/1469009939574239238 …