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 TrumpWarren: Dershowitz presentation 'nonsensical,' 'could not follow it' Bolton told Barr he was concerned Trump did favors for autocrats: report Dershowitz: Bolton allegations would not constitute impeachable offense 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 WaldenHillicon Valley — Presented by Philip Morris International — Wyden asks NSA to investigate White House cybersecurity | Commerce withdraws Huawei rule after Pentagon objects | Warren calls on Brazil to drop Greenwald charges Bipartisan lawmakers call for watchdog probe into government telecom office Conservative groups aim to sink bipartisan fix to 'surprise' medical bills MORE (R-Ore.) and Senate Health Committee Chairman Lamar AlexanderAndrew (Lamar) Lamar AlexanderBolton upends Trump impeachment trial  McConnell urges GOP senators to keep powder dry on witness question Murkowski 'curious' to hear what Bolton has to say 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 MurrayOvernight Health Care: Trump becomes first sitting president to attend March for Life | Officials confirm second US case of coronavirus | Trump officials threaten California funding over abortion law Top health officials brief senators on coronavirus as infections spread Administration to give Senate briefing on coronavirus 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 SchumerMeadows: Republicans who break with Trump could face political repercussions Bolton book alleges Trump tied Ukraine aid freeze to Biden investigations: NYT Trump legal team offers brisk opening defense of president 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 PelosiHouse passes bill aimed at bolstering Holocaust education Hillicon Valley — Presented by Philip Morris International — NFL social media accounts hacked | Dem questions border chief over controversial Facebook group | Clinton says Zuckerberg has 'authoritarian' views Meadows: Republicans who break with Trump could face political repercussions MORE (D-Calif.) has also not commented on the deal, and Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellRepublicans show little enthusiasm for impeachment witness swap Overnight Health Care — Presented by Philip Morris International — CDC, State Department warn against travel to China | Biden says Trump left US unprepared for epidemic | Justices allow Trump 'public charge' rule to move forward Progressive group targeting vulnerable GOP senators on impeachment witnesses 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 CassidySenators opt to drink milk on Senate floor during impeachment trial Big Pharma looks to stem losses after trade deal defeat Trump trade deal faces uncertain Senate timeline MORE (R-La.), Maggie HassanMargaret (Maggie) HassanCyberattacks against North Dakota state government skyrocket to 15M per month Hillicon Valley: Biden calls for revoking tech legal shield | DHS chief 'fully expects' Russia to try to interfere in 2020 | Smaller companies testify against Big Tech 'monopoly power' Bipartisan group of senators introduces legislation to boost state cybersecurity leadership MORE (D-N.H.) and Michael BennetMichael Farrand BennetBiden leads 2020 pack in congressional endorsements Sunday shows preview: Lawmakers prepare for week two of impeachment trial Impeachment throws curveball in Iowa to sidelined senators 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.”