Bipartisan fix for ‘surprise’ medical bills hits roadblock with powerful chairman

A broad bipartisan effort to pass legislation protecting patients from massive “surprise” medical bills is now on life support as House Ways and Means Committee Chairman Richard Neal (D-Mass.) digs in on a separate proposal.

Democratic and Republican leaders of three committees in the House and Senate have been pushing for months to pass their measure, which would prevent Americans from unexpectedly getting hit with medical bills for thousands of dollars for common scenarios like treatment from a doctor outside their insurance network when they require emergency care.

Neal has been holding out for his own rival proposal and has not shown any willingness to budge despite concessions offered by top lawmakers on the three committees.

Speaker Nancy Pelosi (D-Calif.) even stepped in over the weekend to speak to Neal in an effort to get him to compromise, sources said.

Proponents are hoping to get their legislation attached to next week’s year-end government funding package that’s likely to include COVID-19 relief, leaving little time for action.

Supporters say they are extremely frustrated with Neal, given that lawmakers have been working on a bipartisan basis for two years to solve an issue many view as an especially egregious practice that should be low-hanging fruit for Congress. Lawmakers tried to pass the measure last December, but disagreements with Neal derailed the measure.

“We have offered multiple alternatives and suggestions in an effort to find common ground,” said Rep. Greg Walden (Ore.), the top Republican on the Energy and Commerce Committee who is retiring in early January. “For whatever set of reasons, there’s one committee that just can’t take yes for an answer.”

“I’m not one to say it’s over, but I think in this case it’s over, and the responsibility is not with the Energy and Commerce Committee Democrats or Republicans,” he added. “Ways and Means gets to own consumers’ surprise bills.”

Erin Hatch, a Neal spokeswoman, said the chairman “has not seen updated legislative text of any new offer.” Backers of the three-committee approach say they have made plenty of offers and concessions, though the most recent offer is not yet in legislative form.

Hatch said that “a full assessment of these complex issues cannot be made without legislative language.”

“It’s fundamentally dishonest for Rep. Neal to pretend that he does not have sufficient information or language to help end the practice of surprise medical billing,” said a Senate GOP aide.

All sides agree that patients should be protected from getting massive medical bills through no fault of their own. But fierce divisions have emerged over how much the insurer would then pay the doctor or hospital once the patient is taken out of the middle.

The three committees — House Energy and Commerce, House Education and Labor and Senate Health, Education, Labor and Pensions — have in general favored an approach called benchmarking, which sets the payment rate based on the median amount that insurers in that area already pay in-network doctors. That approach is backed by insurers, unions and consumer groups who say it will save both consumers and the government more money than Neal’s proposal.

Hospitals and doctors, on the other hand, warn that would lead to damaging payment cuts. They favor an alternative process where an outside arbiter would decide the payment, through arbitration. That’s the approach proposed by Neal and Rep. Kevin Brady (Texas), the top Republican on the Ways and Means Committee, with Neal touting the support of hospital groups.

Backers of the three-committee approach say they offered a range of concessions to Neal, including one that only used Neal’s preferred method — arbitration — but he still did not agree.

Asked about that concession, Hatch said: “No legislative text including that proposal or any other updates has been shared with Ways and Means for the Chairman and other members to review — a full assessment of these complex issues cannot be made without legislative language.”

The fierce lobbying from powerful doctor and hospital groups has caused further problems. Private equity firms that own doctor staffing companies previously funded millions of dollars in ads against the three-committee legislation.

Surprise billing became an issue in Neal’s primary race earlier this year; his progressive challenger, Alex Morse, accused him of blocking surprise billing legislation because the private equity firm Blackstone is a major contributor to Neal. Neal ended up handily defeating Morse before going on to win reelection to Congress, where he has served since 1989.

Neal is now saying he wants to again delay the issue until next year, which backers of the three-committee approach take as a sign that he does not want to address the issue at all and is trying to delay it indefinitely.

Two of the major backers of the three-committee approach are retiring: Walden and Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate Health Committee.

Alexander, who is close to Senate Majority Leader Mitch McConnell (R-Ky.), is pushing to get the legislation done this year before he retires in early January.

McConnell has not shown his cards on the issue but certainly is not publicly pushing for it.

The GOP leader’s office did not respond to a request for comment.

A senior House Democratic aide confirmed that Neal has not budged, but added that “the long shadow over all of it is that even if the committees reached agreement, McConnell has given no indication that he’d allow any surprise billing fix on the end-of- year package.”

Senate Democratic Leader Charles Schumer (N.Y.) has expressed concerns in the past with the benchmarking payment approach from the three committees, given its impact on New York hospitals, though he did tell colleagues at the end of 2019 that he would not block an agreement.

Schumer’s office declined to comment on Tuesday.

That leaves Pelosi as the main leader pushing for an agreement.

“We continue to work with the committees of jurisdiction to hammer out an agreement on strong legislation to protect patients from surprise billing,” said Pelosi spokesman Henry Connelly.

Jen Taylor, senior director of federal relations at the consumer health care advocacy group Families USA, said Congress has a chance to protect patients from “unfair billing practices and crushing debt.”

“Kicking this down the road once again won’t magically lead to new solutions — it will only extend heartache for people at a time when they can least afford it,” she said.

If the issue does get punted again until next year, some backers say that would kill it for good, despite any assurances it could be revived.

“They’ll say that, but guess what: That’s what they said in 2019,” Walden said. “It’s stunning to me that this can be thrown overboard.”