Pelosi’s staff huddles with aides in both parties on ‘surprise’ medical billing

House aides in both parties met with Speaker Nancy Pelosi’s (D-Calif.) staff on Friday to try to bridge the gap between rival bills to protect patients from getting massive, “surprise” medical bills.

But there was no breakthrough in the meeting, sources said.

The gathering included Democratic and Republican staff members from the three House committees dealing with the issue: Energy and Commerce, Ways and Means, and Education and Labor. Aides to Pelosi and House Minority Leader Kevin McCarthy (R-Calif.) also participated in the meeting.

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

But the effort has been slowed by a rift between the leaders of the Energy and Commerce Committee and the Ways and Means Committee. The two panels have put forward rival bipartisan measures on the issue. 

The bipartisan effort also faces fierce opposition from doctors and hospitals who worry that the Energy and Commerce bill would lead to steep cuts to their payments. Those groups are instead backing the Ways and Means measure.

House leaders are now trying to bridge the divide between the bills. Pelosi has said she wants to include surprise billing legislation in a health care package expected ahead of a May 22 deadline for renewing a range of expiring health care programs like community health centers.

All sides agree that patients should be protected. The main dispute now is over how much the insurer should pay the doctor once the patient is taken out of the middle.

The Energy and Commerce Committee, Senate Health Committee, and Education and Labor Committee all back a proposal to set the payment based on the median amount paid for that service in that geographic area, with the option of going to arbitration for some high-cost bills. That approach is backed by unions and consumer groups.

But doctors and hospitals worry it would lead to damaging cuts to their payments. Some conservative groups and lawmakers also argue the approach is government price setting.

Doctors and hospitals are backing legislation from the Ways and Means Committee, which relies more fully on an outside arbiter to set the price.

Some observers argue the proposals are not that far apart and could be bridged, but it remains to be seen if politics or tensions between the committees will get in the way.

“This was a good week, and a path forward is clearly emerging,” said a senior House GOP aide. “Unless a political wrench is thrown into this equation, there is no reason we cannot reach a deal.”

Staff from House Majority Leader Steny Hoyer (D-Md.) and Minority Whip Steve Scalise’s (R-La.) office also attended. 

“As Mr. Hoyer has stated, he wants to move surprise billing legislation soon,” said Hoyer spokeswoman Mariel Saez. “Now that all three committees of jurisdiction have marked up their bills, the next step is starting the process of reaching consensus in the House. He is glad this has been a productive week moving forward on this priority.”

Updated at 7:27 p.m.