Crunch time for Congress on surprise medical bills

Lawmakers are facing crunch time in a bipartisan push to pass legislation protecting patients from getting hit with massive “surprise” medical bills.

Staff in both chambers and both parties are having what Sen. Bill Cassidy (R-La.) called “intense meetings” to try to come to an agreement in time to be included in a government funding package ahead of a Dec. 20 deadline.

The effort is a rare opportunity for bipartisan action this year, as lawmakers in both parties and President Trump have all called for moving on the issue.

But the effort faces major obstacles. Doctors and hospitals are fiercely lobbying against the leading proposal in Congress, arguing it would cause damaging cuts to their payments.

And it is a challenge to reach any significant bipartisan deal in a Congress bitterly divided over Trump and House Democrats’ impeachment proceedings.

Senate Health Committee Chairman Lamar Alexander (R-Tenn.), one of the leading proponents of the surprise-billing crackdown, had a pointed message for leadership in both parties.

“I think that sooner or later people are going to say we’d like to do more than confirm judges and talk about impeachment,” Alexander told reporters on Wednesday. “Let’s talk about lowering health care costs.”

The legislation would protect patients from getting bills for thousands of dollars when they go to the emergency room and one of the doctors caring for them happens to be outside their insurance network.

Advocates are warning that the clock is ticking.

“Congressional leaders have been talking about fixing surprise bills for over a year now,” said Shawn Gremminger, senior director of federal relations at the liberal health care advocacy group Families USA.

“The first committee hearing on the issue was seven months ago. It is frustrating that we’re coming up on Thanksgiving and don’t have a plan in place.”

Much of the battle centers on how much the insurer will pay the doctor or hospital once the patient is taken out of the middle.

The Senate Health Committee and House Energy and Commerce Committee have both proposed essentially setting the payment rate based on the average price of that service. But doctors and hospitals oppose that idea and are pushing a rival approach that would let an outside arbitrator decide the amount of payment.

Experts have warned that this approach could drive health care costs up, not down.

The Senate Health Committee and House Energy and Commerce Committee are in talks about bridging their two bills, but if successful they would still have to contend with other lawmakers who advocate the approach backed by doctors, like Cassidy.

The agreement between the Senate Health Committee and House Energy and Commerce Committee could move slightly toward the doctor-backed approach, but it is unlikely to move far enough in that direction to assuage the objections from the doctor and hospital groups, sources say.

The two panels are pushing for their measure to be included in the government funding deal in December, but it will ultimately be up to leadership to decide if it gets included.

If Speaker Nancy Pelosi (D-Calif.) included a bipartisan surprise-billing measure in the government funding package, it could be hard for the Senate to reject it, but it is unclear if she will.

A Pelosi spokesman declined to comment on surprise billing and the path forward.

Meanwhile, sources say that Senate Minority Leader Charles Schumer (D-N.Y.) is sympathetic to the concerns raised by hospitals over the Senate Health Committee bill.

Schumer said Tuesday that lawmakers are trying to work out the competing approaches.

“I think we have to do something about surprise billing, and there are two different proposals, and I think the leadership is working that out,” Schumer told reporters.

A spokesman for Senate Majority Leader Mitch McConnell (R-Ky.) also declined to comment on surprise billing.

The House Energy and Commerce Committee is pushing for its bill to be included in the December package, but it faces a competing effort from another House panel, the Ways and Means Committee, which is also working on a bill, though it has struggled to come to agreement.

One lobbyist said doctors and hospitals are hoping Ways and Means puts forward a competing bill that could be an alternative to the Energy and Commerce measure.

“We’re still working on our own bill in a bipartisan manner and will hopefully have a product ready for markup sooner rather than later,” said Ways and Means Democratic spokeswoman Erin Hatch. “But we don’t have a firm timeline.”

There is also competition from another health care priority: lowering drug prices.

Surprise billing legislation would likely be used to help pay for a range of expiring health programs like community health centers. But drug pricing legislation could also be used for that purpose.

Drug pricing faces a tough road, if not tougher, than surprise billing, though, so a deal on that front is far from assured.

Gremminger, of Families USA, said that despite the challenges “members are not as far apart as it might seem” on surprise billing.

But he said they need to act soon.

“It is past time for leaders to buckle down and get this done,” he said.