It’s Time for Reimbursement Parity in Anesthesia

Should insurers be allowed to pay less for the same service simply because of who provides it? Should patients in rural America lose access to care because an insurer decided one qualified provider is worth less than another?

The answer to both questions should be no. Unfortunately, that is not the case.

One example is anesthesia care, where a physician anesthesiologist and a certified registered nurse anesthetist (CRNA) can provide the same service but be reimbursed at different rates. A patient undergoing surgery rarely asks whether their anesthesia is being provided by a CRNA. They ask a simpler question: “Will I be safe?” The answer, for millions of Americans every year, is yes.

Despite providing the same service, some insurance companies reimburse CRNAs at 85% of the physician fee schedule simply based on their provider designation. CRNAs practice in every healthcare setting and are often the sole anesthesia professionals serving rural and underserved communities. They are also primary anesthesia providers caring for our military on the battlefield. In many hospitals, surgery centers, military facilities, and obstetric units, patients would lose access to essential procedures without CRNAs.

Equal work deserves 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 in multiple states. The policy generated immediate backlash from providers and patient advocates. Likewise, UnitedHealthcare implemented a policy reducing reimbursement for independent CRNA services to 85% in most states beginning in 2025. Other insurers have announced similar reductions. And some insurers, such as Kaiser Permanente in Washington state, implemented similar cuts but later reversed course after strong opposition.

These policies are not based on evidence of poorer outcomes or lower-quality care. They are not based on patient safety concerns. They are simply reimbursement decisions that single out one class of providers for reduced payment despite providing the same medically necessary service.

This approach is shortsighted.

When insurers reduce payment to CRNAs, they are not cutting unnecessary costs. They are destabilizing delivery systems that communities rely on. Rural hospitals are already struggling to recruit anesthesia professionals. Lower reimbursement threatens CRNA practices, increases pressure on hospitals operating on thin margins, and may ultimately reduce access to surgical, obstetric, trauma, and pain management services.

Congress should not allow reimbursement policies to create another barrier to healthcare access.

Even though federal law already prohibits many forms of provider discrimination, enforcement remains inconsistent and incomplete. Congress should enact clear national legislation requiring reimbursement parity for anesthesia services when providers are acting within their state scope of practice and delivering the same service.

There is also a free-market argument.

Capitalism works when the market is allowed to determine the value of a service based on factors including quality, availability, and demand. In a functioning market, shortages and demand help shape prices. But when reimbursement structures artificially determine that one qualified provider’s work is worth less than another’s for providing the same service, we move further away from a competitive market.

At a time when America needs more healthcare providers, not fewer, our reimbursement system should encourage competition and efficient models of care rather than create disadvantages for qualified professionals.

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

The debate over anesthesia reimbursement is not merely a dispute among professionals. It is a question of fairness and access.

Equal reimbursement for equivalent anesthesia services is not a radical idea. It is a principle rooted in capitalism, efficiency, and fairness and supported by decades of safe patient care. It is also essential to protecting timely access to this specialized healthcare for all Americans, regardless of where they live.

Congress, regulators, insurers, and healthcare leaders must act to ensure reimbursement policies do not undermine access to care or arbitrarily disadvantage qualified providers.

Patients deserve nothing less.