Congress Must Enforce Reimbursement Parity to Protect Anesthesia Access

Should insurers pay less for identical services based solely on the clinician providing them? Should rural patients lose access to care because a payer values one qualified provider less than another? The answer to both questions must be no, yet current reimbursement practices contradict this principle.

Anesthesia care illustrates the problem. Physician anesthesiologists and certified registered nurse anesthetists (CRNAs) deliver the same service, but some insurers reimburse CRNAs at only 85% of the physician fee schedule. Patients rarely ask which provider type administers their anesthesia; they ask whether they will be safe. For millions of Americans annually, the answer is yes—regardless of provider designation.

CRNAs practice in every healthcare setting and are frequently the sole anesthesia professionals in rural and underserved communities. They serve as primary anesthesia providers for the military on the battlefield. In countless hospitals, surgery centers, military facilities, and obstetric units, essential procedures would cease without them.

Equal work warrants equal pay.

In 2024, Anthem Blue Cross Blue Shield announced that CRNA-only anesthesia services would be reimbursed at 85% of the physician fee schedule across multiple states. The policy drew immediate backlash from providers and patient advocates. UnitedHealthcare followed with a similar reduction for independent CRNA services in most states beginning in 2025. Other insurers have pursued comparable cuts. Kaiser Permanente in Washington state implemented then reversed such reductions after sustained opposition.

These policies lack foundation in evidence of inferior outcomes, diminished quality, or patient safety concerns. They are arbitrary reimbursement decisions that single out one provider class for reduced payment despite the delivery of identical, medically necessary services.

This approach is shortsighted. Reducing payment to CRNAs does not eliminate waste; it destabilizes delivery systems that communities depend on. Rural hospitals already struggle to recruit anesthesia professionals. Lower reimbursement threatens CRNA practices, compounds financial pressure on hospitals operating on thin margins, and may ultimately curtail access to surgical, obstetric, trauma, and pain management services.

Congress should not permit reimbursement policies to erect additional barriers to healthcare access. Although federal law prohibits many forms of provider discrimination, enforcement remains inconsistent and incomplete. Clear national legislation requiring reimbursement parity for anesthesia services—when providers act within their state scope of practice and deliver the same service—is necessary.

A free-market argument also supports parity. Capitalism functions when markets determine service value based on quality, availability, and demand. Shortages and demand should shape prices. When reimbursement structures artificially devalue one qualified provider’s work relative to another’s for the same service, the market ceases to function competitively.

At a time when America needs more healthcare providers, not fewer, reimbursement systems should encourage competition and efficient care models rather than disadvantage qualified professionals.

Reimbursement parity fosters healthy competition and innovation. CRNAs frequently deliver cost-effective anesthesia care, enabling hospitals and surgery centers to expand services while maintaining high quality and patient satisfaction. Penalizing these providers through lower reimbursement discourages efficient models and ultimately harms patients.

The debate over anesthesia reimbursement transcends professional turf wars. It is a question of fairness and access.

Equal reimbursement for equivalent anesthesia services is not radical. It is a principle grounded in capitalism, efficiency, and fairness, supported by decades of safe patient care. It is essential to preserving timely access to specialized healthcare for all Americans, regardless of geography.

Congress, regulators, insurers, and healthcare leaders must act to ensure reimbursement policies neither undermine access to care nor arbitrarily disadvantage qualified providers.

Patients deserve nothing less.

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