Turf fight further complicates surprise billing proposals
JURISDICTIONAL BATTLES are hampering efforts in Congress to address the problem of surprise medical bills. Two competing proposals emerged last week, further muddying the waters lawmakers must navigate.
House Ways and Means Committee leaders Dec. 11 announced vague outlines of a new proposal and ranking Republican member Kevin Brady of Texas told reporters that he wanted to delay action on surprise billing until next year.
The announcement came just days after Senate health committee Chair Lamar Alexander (R-Tenn.), House Energy and Commerce Chair Frank Pallone (D-N.J.) and ranking Republican Greg Walden of Oregon announced a bipartisan deal of their own, which includes an arbitration process. However, Senate health committee ranking Democrat Patty Murray (Wash.) at deadline had not signed on. A spokesperson for Murray said she is still working with Democrats who have concerns about the legislation.
Those supporting the Alexander-Pallone-Walden deal want it included in a year-end spending deal that Congress must pass by midnight Dec. 20 to keep the government running. At deadline, it appeared unlikely that the package would be included in a budget bill congressional leaders were hammering out.
“We have worked that issue all the way through and we basically adopted the House position in our compromise bill. I’m hopeful we can go ahead with it,” Alexander said.
Under this plan, providers would be paid for outof-network care based on a benchmark of the median in-network rate in the area.
The threshold for providers to appeal charges to an outside arbitrator would be $750, and they would not be allowed to bundle charges. The factors an arbiter would be directed to weigh are still unclear.
Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.) and Michael Bennet (D-Colo.), who advocated for the provider-friendly fixes, said they were glad a “simple arbitration safety valve” was included in the legislation, but indicated that discussions may be ongoing.
“As our discussions continue around the final details, we are encouraged that we’re one step closer to giving patients these vital protections,” they said in a statement.
Previously, hospitals have been mixed in their support of arbitration. The American Hospital Association testified before a congressional panel this spring that any legislation should have “baseball-style” arbitration and allow the request for arbitration to come from the provider or health insurer, not the patient.
The White House signaled it is open to supporting surprise billing legislation including an arbitration backstop.
Pallone, Alexander and Walden said their surprise billing fix would save the government nearly $20 billion.
Similarly, details were murky at deadline surrounding the Ways and Means plan. A legislative summary described a “reconciliation process” if providers and insurers cannot agree on payment for emergency or out-of-network care at in-network facilities. The process would consider payments made to similar providers for similar services in similar areas.
The loser in the reconciliation process
would pay a fee, and providers and plans would have to pay a fee if they used the process too often.
The Ways and Means summary did not include cost savings estimates.
“It’s really important to get this solution right, both for patients and for providers and insurers to make sure it’s balanced, so it’s important that Congress not rush into a solution. Chairman Neal and I believe this should be the first issue Congress takes up when we get back after the first of the year,” Brady said, referring to Rep. Richard Neal (D-Mass.)
Shawn Gremminger, senior director of federal relations at Families USA, said the consumer advocacy group is eager for movement by year-end.
“I’m all for Ways and Means being at the table. But not at the expense of delaying this until 2020. There’s a bipartisan, bicameral, fully drafted and fully scored deal on the table. Congress needs to get this done before we go into an election year,” Gremminger said. ●