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Analysis

Did Bipartisanship Just Break the Surprise Billing Logjam?

By Steven Porter  
   December 09, 2019

Republicans and Democrats in Congress say they have reached an agreement on legislation that has been stalled for months, amid intense industry pushback.

A bipartisan group of lawmakers in both the House and Senate announced Sunday that they have reached a deal to ban surprise medical bills, perhaps signaling an end to a months-long legislative standstill.

Committees in both chambers had advanced bills on the topic last summer, but their efforts stalled as groups backed by the healthcare industry launched a public relations campaign against the initiative, arguing it would constitute an unfair form of rate-setting.

Sunday's announcement—from House Energy & Commerce Committee Chairman Frank Pallone Jr., D–New Jersey; ranking member Greg Walden, R–Oregon; and Senate Health Committee Chairman Lamar Alexander, R–Tennessee—says the legislation will reduce out-of-pocket costs for American patients, put  an end to surprise billing, and include a mechanism for arbitration.

"Americans who follow the rules and pay their premiums shouldn't get stuck with a $50,000 bill because a hospital contracted a NICU to an out-of-network provider, or a $109,000 bill after being rushed to a nearby hospital for a heart attack," Walden said in a statement. "To put it plainly: Americans are sick and tired of being ripped off by surprise medical bills, and they want Congress to act."

In addition to addressing surprise medical bills, the legislation would provide $20 billion for five years of funding for Community Health Centers, require more transparency and competition for prescription drugs, and raise the minimum age for tobacco purchases to 21, according to the announcement.

Raising the legal age to purchase tobacco has been a priority for Senate Majority Leader Mitch McConnel, R–Kentucky, as Mary Ellen McIntire reported for Roll Call.

Pallone said he aims to have the measure signed by President Donald Trump by the end of the year. Trump has urged Congress to take action on this issue.

"Congress should pass the bill promptly and give the American people a very good Christmas present," Alexander said.

The deal's boosters aim to include the measure in a government funding deal with a December 20 deadline, as Peter Sullivan reported for The Hill.

The text of the bill hasn't been released publicly.

American Hospital Association President and CEO Rick Pollack made perfectly clear, however, that AHA member institutions didn't put this policy on their wish lists this year.

"Unfortunately, unless this proposal is much improved over previous bills that rely on a benchmark rate, it remains highly problematic and would jeopardize patient access to hospital care, particularly in rural communities," Pollack said in a statement.

"An arbitrary rate gives insurers an incentive to remove hospitals from their networks and force artificially low reimbursement rates, which limits access," he added. "Moreover, such proposals would provide a huge windfall to commercial insurance companies at the expense of the nation’s community hospitals."

Pollack encouraged lawmakers to take their time.

Other Lawmakers' Voices

A key Democrat's name wasn't on the announcement. Sen. Patty Murray, ranking member of the Senate Health Committee, didn't sign onto the announcement. An aide told Politico's Rachel Roubein and Susannah Luthi that Murray believes the agreement is productive and "is working with some members of her caucus on concerns they still have."

A separate joint statement from Sen. Bill Cassidy, MD, R-Louisiana; Sen. Maggie Hassan, D-New Hampshire; and Sen. Michael Bennet, D-Colorado—who had authored one of the earlier bill—praised the new agreement.

"We appreciate committee leadership for their work to progress efforts to end the practice of surprise medical billing, including by adding a simple arbitration safety valve to help providers and plans resolve these billing disputes," Cassidy, Hassan, and Bennet said. "As our discussions continue around the final details, we are encouraged that we’re one step closer to giving patients these vital protections. Patients have waited long enough, and we remain hopeful that we can get this done by the end of the year."

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

Hospitals contend the policy likely 'remains highly problematic and would jeopardize patient access to hospital care.'

The measures supporters are looking to include it in a spending package ahead of a December 20 deadline.


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