Work on surprise medical bills goes into overdrive

Lawmakers are moving quickly to try to notch a bipartisan accomplishment and pass legislation protecting patients from massive surprise medical bills, even as they face headwinds from industry and divisions over competing plans.

Days after President Trump called for action last week, House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) and ranking member Greg Walden (R-Ore.) on Tuesday released a draft bill to tackle the problem, a sign of momentum on the issue.

A bipartisan group of lawmakers in the upper chamber, led by Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.) and Michael Bennet (D-Colo.), plan to release their own legislation this week.

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And Senate Health Committee Chairman Lamar Alexander (R-Tenn.), along with Sen. Patty Murray (D-Wash.), are working on their own measure as part of a broader package to lower health care costs.

The goal is to put an end to viral stories like that of a teacher in Texas last year who received a $108,951 bill from the hospital after his heart attack. Even though the teacher had insurance, the hospital was not in his insurance network.

The effort received a boost after President Trump last week lent his voice to it, urging lawmakers to take action.

Trump said the practice of sticking patients with surprise medical bills “must end.”

“We’re going to hold insurance companies and hospitals totally accountable,” Trump said at a White House event.

And administration officials offered lawmakers a set of guiding principles, letting Congress take the lead on drafting a response.

Trump officials have prioritized making sure that patients have the same out-of-pocket costs in-network or outside and that patients are better informed about potentially unexpected payments.

The flurry of activity on Capitol Hill highlights how lawmakers believe stopping surprise medical bills is a rare area where something bipartisan could be signed into law this year, but there are still strong divisions.

Powerful health care industry groups are already knocking the plans they don’t like and pushing for others, trying to protect themselves from taking a financial hit in the legislation.

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“We are open to feedback and discussion,” Walden told reporters on Tuesday. “We just want to get this done and get results because too many people are getting whacked.”

Lawmakers and industry groups all agree in theory that patients should be protected from getting surprise bills when they go to the emergency room and one or more of the doctors treating them are outside their insurance network.

But the question of deciding how much the insurer will pay the medical provider for that care once the patient is out of the picture is proving to be a stumbling block. Doctors, hospitals and insurers are all fighting over the answer.

The House bill released this week essentially sets the rate that insurers would pay doctors, something that medical provider groups are fighting against.

The American Hospital Association hit back at the House bill, saying it would “impose arbitrary rates on providers.”

Doctors’ groups are instead pushing for an outside arbiter to set the payment amount.

The Senate group that includes Cassidy is planning to use this arbitration approach in the bill it is about to release, Cassidy said.

But that approach might not match up with what the other Senate group is working on.

Alexander and Murray could use a different approach in the bill they hope to unveil next month. That will be a key decision, given that Alexander is the chairman of the Health Committee and controls the package that is expected to be moving to the Senate floor.  

“It is close conversations, it’s very amiable,” Cassidy said of Alexander and Murray’s work.

“I can’t tell you exactly where they’re going to land,” he continued, “but I do think there will be an effort to reconcile what the two groups do.”

The White House has also been getting involved in the discussions. Administration officials told reporters last week that they favor an approach other than having an arbitrator set prices.

“They’re active; they’re not being passive,” Cassidy said of the White House.

Walden said the eventual measure, while protecting patients, also should not drive up health care spending.

“I can make everybody in the provider world happy if I just hit the right payment number, but that’s not what this is about either,” he said.