Upon finishing nursing school, nurses across the country take the Nightingale Pledge and promise to devote their lives to service. Here in Missouri, thousands of nurses have upheld this noble goal and risked their lives on the front line treating almost 80,000 COVID-19 patients. These heroes deserve our respect, and our elected officials should do everything they can to support them.

As the president of the Missouri Nurses Association, it is my job to educate lawmakers and the public on policy choices that will affect front-line nurses and the patients they treat. Congress is currently debating two pieces of legislation that could end the problem of surprise medical billing. Congress is right to tackle this issue that has affected more than half of American adults, according to a 2018 survey. That is why it is critical that members of Congress understand which legislative solutions actually protect patients and nurses in Missouri and which would protect the profits of large health insurance companies.

Surprise medical bills occur when insurance companies unexpectedly raise costs on patients through higher premiums, co-pays or deductibles. Insurers also use their market power to lower the reimbursements that hospitals, physicians and nurses depend on, kicking providers out of network if they do not accept. This leaves providers and patients responsible for the difference of cost between in-network and out-of-network providers. Patients pay expensive premiums every month. Health insurance companies shouldn’t put patients on the hook for surprise bills.

Insurance companies are the most profitable actors in the American health care system. In August, UnitedHealthcare, Gentene and Anthem all announced that their quarterly profits had doubled from the previous year. United took in a staggering $6.6 billion in earnings in just the second quarter.

On the other hand, front-line nurses and health care providers across Missouri continue to struggle amid the COVID-19 pandemic. Since 2014, more than 14 hospitals have closed across the Show-Me State, according to the Missouri Hospital Association. Fewer hospitals and clinics means that patients must drive farther for critical treatment and that hardworking nurses have fewer opportunities in Missouri.

U.S. Sen. Lamar Alexander, R-Tenn., has a legislative solution to surprise medical billing that would exacerbate this problem and lead to more hospital and clinic closures, especially in rural and underserved communities. Alexander’s bill effectively allows insurance companies to set the reimbursement rate that providers depend on to pay for treatment. Insurers would use this power to further lower reimbursements that health care providers depend on to cover the costs of treatments.

This rate-setting legislation would effectively lead to a 20% pay cut for front-line providers. Health care facilities that are already struggling to keep the doors open would lose critical revenue. Earlier this year, more than 160 economists wrote a letter urging Congress to reject this rate-setting approach because “such proposals represent a direct government intervention in health care that would hurt access to care, especially for patients in rural areas.” Organizations representing health care providers across the country oppose rate setting, including the American Hospital Association, the American Medical Association and the Federation of American Hospitals.

Fortunately, U.S. Bill Cassidy, R-La., a former gastroenterologist, has proposed an alternative legislative solution to surprise billing that empowers patients, providers and nurses. Cassidy’s bill is built around an independent dispute resolution process that holds patients harmless and removes them from billing disputes between providers and health insurance companies. IDR has been proven effective at the state level in both New York and Texas because it forces providers and insurers to negotiate and reach a solution.

I urge Missouri's U.S. Sens. Josh Hawley and Roy Blunt to cosponsor Cassidy’s STOP Surprise Medical Bills Act. More than 30 senators from both parties have already supported this commonsense solution because it protects nurses, doctors and patients, not large health insurance companies.

Terry Reese is an advanced practice registered nurse (nurse practitioner) and president of the Missouri Nurses Association.