Obstacles remain for deal on surprise medical bills

Obstacles remain for deal on surprise medical bills
© Greg Nash

Lawmakers on Sunday touted a bipartisan deal on protecting patients from surprise medical bills, but the effort still faces some tough questions before it can reach President TrumpDonald John TrumpProtesters tear down statue of Christopher Columbus in Baltimore 'Independence Day' star Bill Pullman urges Americans to wear a 'freedom mask' in July 4 PSA Protesters burn American flag outside White House after Trump's July Fourth address MORE's desk.

While the announced deal was a boost to efforts to address the complicated issue, supporters still face opposition from powerful industry groups and need to secure the backing of congressional leaders, who have yet to sign on.

And the clock is ticking. Backers of the deal between House Energy and Commerce Committee Chairman Frank Pallone Jr.Frank Joseph PalloneDem chairmen urge CMS to prevent nursing homes from seizing stimulus payments Federal watchdog finds cybersecurity vulnerabilities in FCC systems Overnight Health Care — Presented by That's Medicaid — Deal on surprise medical bills faces obstacles | House GOP unveils rival drug pricing measure ahead of Pelosi vote | Justices to hear case over billions in ObamaCare payments MORE (D-N.J.), Energy and Commerce ranking member Greg WaldenGregory (Greg) Paul WaldenRepublicans are working to close the digital divide Fauci gives Congress COVID-19 warning Fauci: We need more testing, not less MORE (R-Ore.) and Senate Health Committee Chairman Lamar AlexanderAndrew (Lamar) Lamar AlexanderReopening schools seen as vital step in pandemic recovery OVERNIGHT ENERGY: Watchdog accuses Commerce of holding up 'Sharpiegate' report | Climate change erases millennia of cooling: study | Senate nixes proposal limiting Energy Department's control on nuclear agency budget Senate nixes proposal limiting Energy Department's control on nuclear agency budget MORE (R-Tenn.) are trying to include the measure in a year-end government funding package, which must pass before a Dec. 20 deadline.

ADVERTISEMENT

Key committee leaders are signing on, but the top Democratic and Republican leaders in each chamber have not endorsed the deal. And the American Hospital Association, an influential group in Washington, is also opposed, worried the measure would result in damaging cuts to payments to hospitals. Doctors and hospitals have been lobbying hard on the measure, and that work is likely to ramp up as the year draws to a close.

Protecting patients from getting massive bills when they go to the emergency room and one of their doctors happens to be outside their insurance network is a rare area of potential bipartisan action this year. Lawmakers from both parties have been negotiating for months, and President Trump has also encouraged those efforts. The White House on Monday praised the deal.

But whether the deal can actually become law this year could depend on the broader negotiations on government funding and health care measures like lowering drug prices and delaying taxes in ObamaCare, as well as on whether lawmakers can overcome staunch industry opposition.

Sen. Patty MurrayPatricia (Patty) Lynn MurrayTrump officials seek to reassure public about safety of a potential coronavirus vaccine Overnight Health Care: Trump refuses to say if he slowed down coronavirus testing | US COVID-19 cases rise, marking ugly contrast with Europe | Trump health officials to testify on continued dangers of coronavirus pandemic The Hill's Coronavirus Report: Rep. Mark Takano says Congress must extend worker benefits expiring in July; WHO reports record spike in global cases MORE (D-Wash.), the top Democrat on the Senate Health Committee, has notably not signed on to the deal.

“Senator Murray is working through members’ concerns and is very hopeful a final agreement can be reached that’s consistent with the goal she’s had throughout this process: ending surprise billing in a way that doesn’t shift costs back onto patients in other ways,” said Helen Hare, a Murray spokeswoman.

Senate Democratic Leader Charles SchumerChuck SchumerPublic awareness campaigns will protect the public during COVID-19 Republicans fear backlash over Trump's threatened veto on Confederate names Overnight Defense: House panel votes to ban Confederate flag on all Pentagon property | DOD report says Russia working to speed US withdrawal from Afghanistan | 'Gang of Eight' to get briefing on bounties Thursday MORE (N.Y.) is also a major question mark. He has been sympathetic to objections raised by hospitals to the measure.

ADVERTISEMENT

His spokesman reiterated that Schumer wants a solution to the problem of surprise billing in general but did not weigh in on the latest specific proposal.

“Senator Schumer absolutely believes patients should be protected from surprise medical billing,” a Schumer spokesman said.

“This is one piece of many health care related proposals that are being considered by various committees in both chambers of Congress," the spokesman added. "Senator Schumer believes you’ve got to look at all of them together as a whole to get the best deal for working Americans."

One influential group in Schumer's home state, the Greater New York Hospital Association, blasted the deal on Monday.

“This rush to get surprise billing language into an end-of-year funding bill, without regard to real-world consequences to health care providers, is dangerous and unnecessary,” the group said. “We encourage Congress to slow down and ensure that this important policy is done thoughtfully and correctly.”

Speaker Nancy PelosiNancy PelosiOn The Money: Breaking down the June jobs report | The biggest threats facing the recovery | What will the next stimulus bill include? Military bases should not be renamed, we must move forward in the spirit of reconciliation Pelosi: Trump 'himself is a hoax' MORE (D-Calif.) has also not commented on the deal, and Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellPublic awareness campaigns will protect the public during COVID-19 Democrats: A moment in history, use it wisely 'Comrade' Trump gets 'endorsement' from Putin in new mock ad by Lincoln Project MORE (R-Ky.) said only that he is “reviewing” it.

The deal though includes a significant sweetener to try to win McConnell's support, a provision to raise the legal age for buying tobacco products to 21, a major priority for the industry and the Senate GOP leader, whose state is one of the nation's largest tobacco producers.

It is also unclear if other senators who were working on a rival surprise billing proposal will jump on board.

The key dispute for months has been how much insurers will pay doctors for a service once the patient is taken out of the middle.

The deal announced Sunday would set the payment rate based on the average amount that is paid for the service in that area. Doctors and hospitals have been pushing for a rival approach that would let an outside arbitrator decide the payment amount.

The new agreement moves slightly toward the doctors' position by allowing high-cost bills — those that cost more than $750 — to go to arbitration, but doctors and hospitals are not satisfied.

A key group of lawmakers have backed the doctor-favored approach, including Sens. Bill CassidyWilliam (Bill) Morgan CassidyWhy drug costs for older Americans should be capped in pandemic's wake Ready Responders CEO Justin Dangel stresses importance of Medicaid population; Fauci says he won't attend Trump rally this weekend Senate advances public lands bill in late-night vote MORE (R-La.), Maggie HassanMargaret (Maggie) HassanSenators press IRS chief on stimulus check pitfalls Hillicon Valley: Livestreaming service Twitch suspends Trump account | Reddit updates hate speech policy, bans subreddits including The_Donald | India bans TikTok Senators move to boost state and local cybersecurity as part of annual defense bill MORE (D-N.H.) and Michael BennetMichael Farrand BennetHouse Democrats chart course to 'solving the climate crisis' by 2050 'The Senate could certainly use a pastor': Georgia Democrat seeks to seize 'moral moment' Some realistic solutions for income inequality MORE (D-Colo.), a 2020 presidential candidate.

ADVERTISEMENT

That group also has not endorsed the deal, though they said they are “encouraged” as the “final details” are worked out.

The deal also includes a range of other health care measures aimed at lowering costs, such as requiring drug companies to provide justifications to the government for large price increases and banning anti-competitive clauses that hospitals use in contracts with insurers.

Backers hope those will bring over enough votes to take the bill across the finish line.

“This agreement will make health care and prescription drugs more affordable for the American people,” Pallone said in a statement. “I’m hopeful that this bipartisan, bicameral agreement can be voted on quickly so that it can be signed into law before the end of the year.”