Lawmakers pushing to include surprise medical billing in coronavirus package

A bipartisan effort is underway to include legislation in the Senate’s $1 trillion coronavirus package that would protect patients from surprise medical bills, The Hill confirmed Wednesday.

A last-minute push from Sen. Lamar Alexander (R-Tenn.) and Rep. Frank Pallone Jr. (D-N.J.) seeks to include language that is favored by insurers, rather than doctors and hospitals, according to sources familiar with the effort.

The provision, similar to what was included in separate bills from the House Energy and Commerce Committee and the Senate Health Committee, would let the government set provider rates based on the average price for in-network services offered in a geographical area, a practice known as “benchmarking.”

Protecting patients from receiving medical bills for thousands of dollars after receiving care from an out-of-network doctor had been seen as a rare area of possible bipartisan agreement this year.

But the effort has been slowed by an array of competing proposals and intense lobbying from doctors and hospitals, who worry it would lead to damaging cuts to their payments. Some conservative groups and lawmakers also argue the approach is akin to government price-setting.

A House Democratic aide confirmed the effort on Wednesday, expressing dismay at the timing as lawmakers scramble to respond to the coronavirus outbreak.

“Now is not the time to be doing this because it’s not an emergency. What is an emergency is to deal with a pandemic. Trying to sneak this is in now is not the most prudent decision,” the aide said.

The push to include the provision was first reported by Morning Consult.

House leaders thought they had an opportunity to pass surprise billing legislation late last year, but a rift between the leaders of the Energy and Commerce Committee and the Ways and Means Committee resulted in rival bipartisan measures on the issue. 

The main dispute is over how much the insurer will pay the doctor or hospital once the patient is taken out of the middle. 

The Ways and Means bill, which gives the decision on payment to an outside arbiter, is favored by doctors, hospitals and private-equity owned physician staffing companies.

Hospitals are likely to get financial relief as part of the coronavirus legislation, and they view efforts to insert surprise billing language into the package as an opportunistic attempt to force the issue.

“The timing is inelegant,” said a provider lobbyist. “We’re still fully on board with addressing surprise billing, but imperiling providers seems counter to what we’re scrambling to do” with the coronavirus bill, the provider said.