Work on surprise medical bills goes into overdrive

Work on surprise medical bills goes into overdrive
© iStock

Lawmakers are moving quickly to try to notch a bipartisan accomplishment and pass legislation protecting patients from massive surprise medical bills, even as they face headwinds from industry and divisions over competing plans.

Days after President TrumpDonald TrumpMyPillow CEO to pull ads from Fox News Haaland, Native American leaders press for Indigenous land protections Simone Biles, Vince Lombardi and the courage to walk away MORE called for action last week, House Energy and Commerce Committee Chairman Frank Pallone Jr.Frank Joseph PalloneIntercept bureau chief: Democrats dropping support of Medicare for All could threaten bill's momentum House Democrats reintroduce road map to carbon neutrality by 2050 House Democrats criticize Texas's 'shortcomings in preparations' on winter storms MORE (D-N.J.) and ranking member Greg WaldenGregory (Greg) Paul WaldenEx-Sen. Cory Gardner joins lobbying firm Ex-Rep. John Shimkus joins lobbying firm Lobbying world MORE (R-Ore.) on Tuesday released a draft bill to tackle the problem, a sign of momentum on the issue.

A bipartisan group of lawmakers in the upper chamber, led by Sens. Bill CassidyBill CassidyTop Democrat: 'A lot of spin' coming from White House on infrastructure The Hill's 12:30 Report - Presented by Facebook - US gymnast wins all-around gold as Simone Biles cheers from the stands The Hill's Morning Report - Presented by Facebook - A huge win for Biden, centrist senators MORE (R-La.), Maggie HassanMargaret (Maggie) HassanThe Hill's Morning Report - Presented by Facebook - Officers recount the horror of Jan. 6 Trump says he'd like to see Chris Sununu challenge Hassan Poll: Potential Sununu-Hassan matchup in N.H. a dead heat  MORE (D-N.H.) and Michael BennetMichael Farrand BennetLawmakers can't reconcile weakening the SALT cap with progressive goals How Sen. Graham can help fix the labor shortage with commonsense immigration reform For true American prosperity, make the child tax credit permanent MORE (D-Colo.), plan to release their own legislation this week.

ADVERTISEMENT

And Senate Health Committee Chairman Lamar AlexanderLamar AlexanderAuthorities link ex-Tennessee governor to killing of Jimmy Hoffa associate The Republicans' deep dive into nativism Senate GOP faces retirement brain drain MORE (R-Tenn.), along with Sen. Patty MurrayPatricia (Patty) Lynn MurrayDemocrats consider scaling back new funds to fight next pandemic Tech executives increased political donations amid lobbying push Schumer, Tim Scott lead as Senate fundraising pace heats up MORE (D-Wash.), are working on their own measure as part of a broader package to lower health care costs.

The goal is to put an end to viral stories like that of a teacher in Texas last year who received a $108,951 bill from the hospital after his heart attack. Even though the teacher had insurance, the hospital was not in his insurance network.

The effort received a boost after President Trump last week lent his voice to it, urging lawmakers to take action.

Trump said the practice of sticking patients with surprise medical bills “must end.”

“We’re going to hold insurance companies and hospitals totally accountable,” Trump said at a White House event.

And administration officials offered lawmakers a set of guiding principles, letting Congress take the lead on drafting a response.

Trump officials have prioritized making sure that patients have the same out-of-pocket costs in-network or outside and that patients are better informed about potentially unexpected payments.

The flurry of activity on Capitol Hill highlights how lawmakers believe stopping surprise medical bills is a rare area where something bipartisan could be signed into law this year, but there are still strong divisions.

Powerful health care industry groups are already knocking the plans they don’t like and pushing for others, trying to protect themselves from taking a financial hit in the legislation.

ADVERTISEMENT

“We are open to feedback and discussion,” Walden told reporters on Tuesday. “We just want to get this done and get results because too many people are getting whacked.”

Lawmakers and industry groups all agree in theory that patients should be protected from getting surprise bills when they go to the emergency room and one or more of the doctors treating them are outside their insurance network.

But the question of deciding how much the insurer will pay the medical provider for that care once the patient is out of the picture is proving to be a stumbling block. Doctors, hospitals and insurers are all fighting over the answer.

The House bill released this week essentially sets the rate that insurers would pay doctors, something that medical provider groups are fighting against.

The American Hospital Association hit back at the House bill, saying it would “impose arbitrary rates on providers.”

Doctors’ groups are instead pushing for an outside arbiter to set the payment amount.

The Senate group that includes Cassidy is planning to use this arbitration approach in the bill it is about to release, Cassidy said.

But that approach might not match up with what the other Senate group is working on.

Alexander and Murray could use a different approach in the bill they hope to unveil next month. That will be a key decision, given that Alexander is the chairman of the Health Committee and controls the package that is expected to be moving to the Senate floor.  

“It is close conversations, it’s very amiable,” Cassidy said of Alexander and Murray’s work.

“I can’t tell you exactly where they’re going to land,” he continued, “but I do think there will be an effort to reconcile what the two groups do.”

The White House has also been getting involved in the discussions. Administration officials told reporters last week that they favor an approach other than having an arbitrator set prices.

“They’re active; they’re not being passive,” Cassidy said of the White House.

Walden said the eventual measure, while protecting patients, also should not drive up health care spending.

“I can make everybody in the provider world happy if I just hit the right payment number, but that’s not what this is about either,” he said.