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 TrumpWith VP pick, Biden can't play small ball in a long ball world Coronavirus hits defense contractor jobs Wake up America, your country doesn't value your life 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 PalloneOvernight 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 Obstacles remain for deal on surprise medical bills This week: House impeachment inquiry hits crucial stretch MORE (D-N.J.), Energy and Commerce ranking member Greg WaldenGregory (Greg) Paul WaldenGOP lawmaker: US will see improvement on virus 'in a couple of weeks' Pelosi not invited by Trump to White House coronavirus relief bill's signing CARES Act delivers on our health care needs in a big way MORE (R-Ore.) and Senate Health Committee Chairman Lamar AlexanderAndrew (Lamar) Lamar AlexanderSticking points force stimulus package talks to spill into Sunday GOP drafting stimulus package without deal with Democrats Senate coronavirus stimulus talks spill into Saturday 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 MurraySenate coronavirus stimulus talks spill into Saturday Senate Democrats propose canceling student loan payments during coronavirus Stimulus plan hinges on McConnell, Schumer repairing toxic relationship 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 SchumerCharles (Chuck) Ellis SchumerTexas man arrested for allegedly threatening Democrats over coronavirus bill Pelosi not invited by Trump to White House coronavirus relief bill's signing COVID-19, Bill Barr and the American authoritarian tradition 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 PelosiSunday shows preview: Lawmakers, state governors talk coronavirus, stimulus package and resources as pandemic rages on Attacking the Affordable Care Act in the time of COVID-19 DC argues it is shortchanged by coronavirus relief bill MORE (D-Calif.) has also not commented on the deal, and Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellCoronavirus pushes GOP's Biden-Burisma probe to back burner Struggling states warn coronavirus stimulus falls short Hillicon Valley: Apple rolls out coronavirus screening app, website | Pompeo urged to crack down on coronavirus misinformation from China | Senators push FTC on price gouging | Instacart workers threaten strike 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 CassidyTensions boil over on Senate floor amid coronavirus debate  Overnight Energy: Democratic lawmakers seek emissions reductions in airline bailout | House Dems warn Trump against oil industry bailout | GOP senators ask Saudis to stabilize oil market GOP senators ask Saudis to stabilize oil market MORE (R-La.), Maggie HassanMargaret (Maggie) HassanWho should be the Democratic vice presidential candidate? Overnight Health Care: Trump triggers emergency powers in coronavirus fight | McConnell sets first stimulus vote for Sunday | Five sticking points for stimulus talks | Treasury delays tax filing deadline | Dems push insurers to cover virus tests Democrats press insurers to cover all coronavirus testing MORE (D-N.H.) and Michael BennetMichael Farrand BennetHillicon Valley: Facebook launches portal for coronavirus information | EU sees spike in Russian misinformation on outbreak | Senate Dem bill would encourage mail-in voting | Lawmakers question safety of Google virus website We need a massive economic response to counter the threat of the coronavirus Senator calls for cybersecurity review at health agencies after hacking incident 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.”