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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 TrumpTrump rages against '60 Minutes' for interview with Krebs Cornyn spox: Neera Tanden has 'no chance' of being confirmed as Biden's OMB pick Pa. lawmaker was informed of positive coronavirus test while meeting with Trump: report 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 PalloneHouse Democrats urge Amazon to investigate, recall 'defective' products Asbestos ban stalls in Congress amid partisan fight Pharma execs say FDA will not lower standards for coronavirus vaccine MORE (D-N.J.), Energy and Commerce ranking member Greg WaldenGregory (Greg) Paul WaldenHillicon Valley: Leadership changes at top cyber agency raise national security concerns | Snapchat launches in-app video platform 'Spotlight' | Uber, Lyft awarded federal transportation contract Lawmakers urge FCC to assist in effort to rip out, replace suspect network equipment OVERNIGHT ENERGY: Barrasso to seek top spot on Energy and Natural Resources Committee | Forest Service finalizes rule weakening environmental review of its projects | Biden to enlist Agriculture, Transportation agencies in climate fight MORE (R-Ore.) and Senate Health Committee Chairman Lamar AlexanderAndrew (Lamar) Lamar AlexanderCongress set for chaotic year-end sprint We need a college leader as secretary of education As Biden administration ramps up, Trump legal effort drags on MORE (R-Tenn.) are trying to include the measure in a year-end government funding package, which must pass before a Dec. 20 deadline.

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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 MurrayNational reading, math tests postponed to 2022 amid coronavirus surge Democratic anger rises over Trump obstacles to Biden transition DOJ investigation into Epstein deal ends without recommended action 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 SchumerThe five biggest challenges facing President-elect Biden Collins urges voters to turn out in Georgia runoffs Protect America's houses of worship in year-end appropriations package MORE (N.Y.) is also a major question mark. He has been sympathetic to objections raised by hospitals to the measure.

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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 PelosiObama chief economist says Democrats should accept smaller coronavirus relief package if necessary The five biggest challenges facing President-elect Biden Democrats were united on top issues this Congress — but will it hold? MORE (D-Calif.) has also not commented on the deal, and Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellFive things to know about Georgia's Senate runoffs Obama chief economist says Democrats should accept smaller coronavirus relief package if necessary Memo to Biden: Go big — use the moment to not only rebuild but to rebuild differently 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 CassidyBill CassidyMcConnell halts in-person Republican lunches amid COVID-19 surge As Biden administration ramps up, Trump legal effort drags on The Hill's Morning Report - Presented by the UAE Embassy in Washington, DC - Trump OKs transition; Biden taps Treasury, State experience MORE (R-La.), Maggie HassanMargaret (Maggie) HassanCut tariffs and open US economy to fight COVID-19 pandemic Senate passes bill to secure internet-connected devices against cyber vulnerabilities Overnight Defense: Trump campaign's use of military helicopter raises ethics concerns | Air Force jets intercept aircraft over Trump rally | Senators introduce bill to expand visa screenings MORE (D-N.H.) and Michael BennetMichael Farrand BennetDemocratic senators urge Facebook to take action on anti-Muslim bigotry Hickenlooper ousts Gardner in Colorado, handing Democrats vital pickup Lobbying world MORE (D-Colo.), a 2020 presidential candidate.

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.”