Turf war derails bipartisan push on surprise medical bills

A bipartisan bill to protect patients from surprise medical bills is not expected to pass this year due to sharp divisions over the legislation, according to congressional aides in both parties. 

House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.), Rep. Greg Walden (R-Ore.) and Senate Health Committee Chairman Lamar Alexander (R-Tenn.) had been pushing for their deal to be included in a year-end government funding package next week. 

The White House also praised their legislation and called for it to pass this year. 

But aides say the legislation is slated to be left out of the must-pass year-end package, causing deep frustration for backers of the effort, which had been seen as a rare area of possible bipartisan action this year. Backers fear the effort will die if the bill is left out of this year’s must-pass government funding bill.  

A crucial reason for the delay is a rival bill that House Ways and Means Committee Chairman Richard Neal (D-Mass.) and Rep. Kevin Brady (R-Texas) released on Wednesday. 

With the key committees in the House pushing competing ideas, leadership is waiting until next year, though supporters worry waiting means nothing will get done once election-year politics kick into gear. 

“There are significant differences between the committees of jurisdiction that take time to iron out,” said a senior House Democratic aide. “Democrats are determined to get surprise billing done, and there will be plenty of vehicles in the new year.”

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

While the goal has drawn widespread support, the details of how to fix the problem have been the subject of intense disagreement and lobbying by industry groups. 

Doctors and hospitals have been lobbying hard against the Energy and Commerce and Senate Health Committee deal, worrying it will lead to damaging cuts to their payments. 

Backers of that deal have expressed deep frustration that the effort is now slipping into next year. 

“It’s extremely disappointing that a bicameral, bipartisan deal backed by the White House to protect patients from surprise billing appears to have gone off the rails,” Walden told The Hill in a statement. “You wonder who made the call to stop our bill, but clearly the best interest of the patient is not at heart.”  

Backers are frustrated with Neal, who they say is throwing a wrench in the effort. They also point to the influence of private equity firms that own doctor staffing companies and are running millions of dollars in ads against the Energy and Commerce legislation. 

“Every day that goes by is another loss for America’s families and another win for private equity,” said Shawn Gremminger, senior director of federal affairs for Families USA, an advocacy group that is a close ally of Democrats on health care. “The primary committees of jurisdiction have been negotiating a deal for months and now there is a bipartisan, bicameral bill on the table that has the support of the White House and can pass by Dec. 20. I’m sorry that Ways and Means missed the boat on this one, but time’s up.”

A congressional source who supports the House Energy and Commerce and Senate Health Committee deal called the Ways and Means proposal a “total joke” and said they were engaged in a “jurisdictional pissing match.”

Neal, though, has called for slowing down, saying more time is needed to work on the policy. 

“Given our jurisdiction, it is crucial that we get this right,” Neal and Brady said in a joint statement earlier this week. 

Asked to respond to the criticism of Neal, his spokeswoman, Erin Hatch, pointed to statements of support for his legislation from a variety of doctor and hospital groups. 

A spokeswoman for Sen. Maggie Hassan (D-N.H.), who has been working with the Senate Health Committee on its proposal, said it is “extremely disappointing that now, at the eleventh hour, turf wars in the House and corporate special interests appear to be standing in the way of passing these vital protections for patients into law.”

A GOP source, meanwhile, blamed Speaker Nancy Pelosi (D-Calif.) for not stepping in and overruling Neal to place the Energy and Commerce and Senate Health Committee deal in the funding bill, calling her the “roadblock.”

Senate Minority Leader Charles Schumer (D-N.Y.) has also expressed sympathy for hospitals’ concerns with the legislation. But a congressional source said Schumer is not holding up the deal.

It is possible there will be another health package moving early next year that could give the surprise billing effort another chance. Some lawmakers are pushing for a short-term extension of expiring health programs like community health center funding, which would set up another package of must-pass health legislation early next year. But aides say it remains up in the air whether those programs will get a short or long-term extension in next week’s package. 

The crucial disagreement on the surprise billing legislation is how much the insurer should pay the doctor once the patient is protected. The Energy and Commerce bill calls for essentially setting the payment rate that the insurer would pay the doctor based on the average payment for that service in that geographic area. The Ways and Means legislation instead leaves that decision up to an outside arbiter.