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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 TrumpTrump vows 'No more money for RINOS,' instead encouraging donations to his PAC Federal judge rules 'QAnon shaman' too dangerous to be released from jail Pelosi says Capitol riot was one of the most difficult moments of her career 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 reintroduce road map to carbon neutrality by 2050 House Democrats criticize Texas's 'shortcomings in preparations' on winter storms House panel to probe conspiracy theories in the news MORE (D-N.J.), Energy and Commerce ranking member Greg WaldenGregory (Greg) Paul WaldenHere are the three GOP lawmakers who voted for the Equality Act Lobbying world Bottom line MORE (R-Ore.) and Senate Health Committee Chairman Lamar AlexanderLamar AlexanderRoy Blunt won't run for Senate seat in 2022 Congress addressed surprise medical bills, but the issue is not resolved Trump renominates Judy Shelton in last-ditch bid to reshape Fed 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 MurrayGOP votes in unison against COVID-19 relief bill Murray blasts GOP measure on transgender athletes: 'Have a little bit of heart' Senate inches toward COVID-19 vote after marathon session 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 SchumerManchin firm on support for filibuster, mulls making it 'a little bit more painful' to use Biden takes victory lap after Senate passes coronavirus relief package Lawmakers demand changes after National Guard troops at Capitol sickened from tainted food 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 PelosiPelosi says Capitol riot was one of the most difficult moments of her career Hillary Clinton calls for women to 'repair' COVID-19's 'damage' on women's rights Republicans' stonewall forces Democrats to pull bill honoring Capitol Police MORE (D-Calif.) has also not commented on the deal, and Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellTrump ramps up battle with Republican leadership RNC fires back at Trump, says it 'has every right' to use his name in fundraising appeals Blunt retirement shakes up Missouri Senate race 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 CassidyEnergy Department announces million toward carbon capture, industrial assessment centers Bottom line Trump was unhinged and unchanged at CPAC MORE (R-La.), Maggie HassanMargaret (Maggie) HassanSenate approves sweeping coronavirus measure in partisan vote Senate rejects Cruz effort to block stimulus checks for undocumented immigrants The eight Democrats who voted 'no' on minimum wage MORE (D-N.H.) and Michael BennetMichael Farrand BennetSenators introduce bill creating technology partnerships to compete with China Democrats push Biden to include recurring payments in recovery package Democrats: Minimum wage isn't the only issue facing parliamentarian MORE (D-Colo.), a 2020 presidential candidate.

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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.”