Democrats divided on surprise medical bill fix

Divisions are emerging among House Democrats as they struggle to move forward with an effort to protect patients from getting massive “surprise” medical bills.

The House Education and Labor Committee was forced to delay a vote it had planned for last week because its members could not come to agreement on the legislation. 

The divisions within the Democratic caucus and between the two parties threaten what was touted as a rare opportunity for Congress to enact bipartisan health care legislation this year.

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Lawmakers in both parties say they want to protect patients from getting large bills when they go to the emergency room and it later turns out one or more of the doctors there was outside their insurance network. But lawmakers have so far been unable to agree on how to do so amid a fierce lobbying blitz from doctors and hospitals worried that one of the leading proposals would result in cuts to their payments. 

Adding to the delays, three different House committees, all controlled by Democrats, are working on their own rival bills.

Republicans have seized on the issue of surprise medical bills as a way to support action on health care that gets away from the politically damaging effort to repeal ObamaCare. Some Democrats, meanwhile, are resisting giving Republicans a win on the issue without addressing what they call the Trump administration’s “sabotage” of the Affordable Care Act and a lawsuit they are backing to scrap it.  

At the center of the congressional debate over surprise billing is how the insurer should pay the doctor once the patient is taken out of the picture. A bipartisan bill that passed the House Energy and Commerce Committee in July would essentially set the payment rate that insurers paid doctors. But doctors warn that approach would lead to damaging cuts to their payments. They are pushing instead for an outside arbiter to help resolve billing disputes.

A group called Doctor Patient Unity, which receives funding from doctor staffing companies, has run millions of dollars in ads against the approach used in the Energy and Commerce legislation. 

The Labor committee was going to vote on a similar bill last week but delayed it amid a push by some lawmakers to instead use the arbitration approach favored by doctors and hospitals, according to House aides and lobbyists. 

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Democratic Reps. Donna Shalala (Fla.) and Joe Morelle (N.Y.) and a Republican, Rep. Phil Roe (Tenn.), all members of the Education and Labor Committee, are leading the push for arbitration. 

Laura Wooster, associate executive director of the American College of Emergency Physicians, said the delay of the committee vote is helpful in giving the group more time to push for its favored approach. 

“It provides more time for us to educate members of the committee,” Wooster said.

Meanwhile, the House Ways and Means Committee appears to be the farthest behind of the three committees and does not have a timeline for producing the bill that it is working on. 

“We want to get it right, that’s the most important thing,” committee Chairman Richard Neal (D-Mass.) told reporters earlier this month. Neal declined to give a timetable for releasing a bill or voting on it. 

He said it is “hard to say” whether the committee is leaning toward using the arbitration approach favored by doctors.  

And the fight over legislation is getting heated.

Supporters of the Energy and Commerce Committee’s rate-setting approach say they think doctors groups are really just trying to kill the entire effort to protect patients from surprise medical bills and maintain the status quo. 

The bipartisan leaders of the panel, Chairman Frank Pallone Jr. (D-N.J.) and ranking member Greg Walden (R-Ore.), last week launched an investigation into the private equity companies that own two major doctor staffing companies that are funding ads against their legislation. 

“These guys are making a lot of money off the backs of patients who are playing by the rules to the best of their ability,” Walden said in a joint interview with Pallone on MSNBC earlier this month. 

The nonpartisan Congressional Budget Office found that using the arbitration approach favored by doctors would reduce the savings from the bill from lower premiums, because the approach would lead to higher payment rates to doctors. 

Across the Capitol, the Senate is also working on bipartisan legislation using a rate-setting approach. But that measure is also mired in delays, with no clear timeline for the upper chamber to vote on it. Sen. Bill Cassidy (R-La.) is leading the effort there to push the legislation toward the arbitration system favored by doctors. 

For now, House leaders insist they are moving forward on surprise billing legislation despite the deep divides.

Asked about the delay in the committee vote last week, an aide to House Education and Labor Committee Chairman Bobby Scott (D-Va.) said he is committed to moving forward but did not provide details. 

“The chairman is committed to advancing bipartisan legislation to protect patients from out of pocket medical costs,” the aide said.