The House Ways and Means and House Education and Labor Committees this week both passed the surprise billing legislation that they each announced last week [see Washington Highlights, Feb. 7]. Ahead of both markups, the AAMC released a statement applauding the Ways and Means Committee for their legislation and thanking the other committees of jurisdiction for their work on the issue.
AAMC Chief Public Policy Officer Karen Fisher, JD, said that the ways and means proposal would “take critical steps to hold patients harmless from surprise medical bills. In addition to protecting patients and their families, the Committee’s approach promotes a fair resolution process for billing disputes between providers and insurers.”
The House Ways and Means Committee Feb. 12 marked up and passed by voice vote the Consumer Protections Against Surprise Medical Bills Act of 2020 (H.R. 5826), introduced by Chairman Richard Neal (D-Ma.) and Ranking Member Kevin Brady (R-Texas). The Ways and Means proposal, like the other current proposals, holds patients harmless from surprise medical bills. However, instead of resolving billing disputes by setting a benchmark rate, the Ways and Means approach would establish a 30-day negotiation period between providers and insurance plans that includes an option to move to baseball-style arbitration if an agreement cannot be reached.
Opening the markup, Chairman Neal said that the Ways and Means legislation would ensure that negotiations between providers and insurance plans would remain balanced.
“My concern with giving too much weight to such a benchmark rate is that we already know insurers are looking for any way they can to pay the least amount possible,” Neal said. “They will work to push those rates down, regardless of what it means for community providers like physicians, hospitals, and our constituents who they employ.”
Ranking Member Brady agreed with Neal’s assessment, stating, “It is fair to all parties, favoring no one but the patient.”
Throughout the markup, other committee members agreed with the Chair and Ranking Member with Rep. Jodey Arrington (R-Texas) calling the legislation the “most reasonable, most appropriate” way to resolve surprise medical bills.
Rep. Lloyd Doggett (D-Texas) proposed, but ultimately withdrew, three amendments to the legislation. The amendments addressed timelines for Explanation of Benefits, qualifications of independent arbiters, and patient protections around delaying scheduled care. He was offered a guarantee by Chairman Neal that his concerns would be addressed as negotiations moved forward.
During the markup, the committee also considered two other pieces of legislation, the Helping Our Senior Population in Comfort Environments (HOSPICE) Act (H.R. 5821) and the Transparency in Health Care Investments Act (H.R. 5825). While both bills passed by voice vote, the latter, which would impose transparency measures on private equity firms investing in health care facilities, was the subject of contentious debate.
The House Education and Labor Committee marked up and passed the Ban Surprise Billing Act (H.R. 5800) Feb. 11 in a 32-13 vote. The legislation, introduced last week, largely follows the approach of the previously proposed House Energy and Commerce and Senate Health, Education, Labor, and Pensions (HELP) Committees’ agreement [see Washington Highlights, Dec. 12, 2019]. H.R. 5800 would resolve billing disputes between providers and insurance plans by setting a median in-network benchmark rate with the option of arbitration for bills over $750.
While the committee ultimately advanced the legislation, several members expressed concerns with the approach, particularly with the legislation’s mechanism to resolve surprise billing disputes by imposing a benchmark rate for payment.
“I have problems with it because it's not balanced. What I mean by that is the insurance companies are the big winners. The hospitals in my district and their employees get hurt, and they're the largest employers in my district," said Rep. Donna Shalala (D-Fla.), a co-sponsor of the Ways and Means proposal.
Rep. Kim Schrier (D-Wash.) agreed with Shalala’s concerns, explaining that this “essentially becomes a choice between whether you are going to just let doctors and insurance companies work this out in a neutral way or whether you’re going to put a thumb on the scale that benefits insurance companies and does nothing more to protect patients.”
Reps. Shalala, Schrier, Morelle (D-N.Y.), and Roe (R-Tenn.) each proposed amendments that would have expanded arbitration in the legislation — all of which failed to pass.
Prior to both markups, the Congressional Budget Office projected that H.R. 5826 would save $17.77 billion over 10 years. While no official score on the House Energy and Commerce and Senate HELP Committee proposal has been released publicly, an unofficial report stated that it is likely to save an estimated $24 billion over 10 years.
President Donald Trump has urged congressional leaders to come up with a solution, with the White House raising concerns on Tuesday about arbitration, stating that it could increase health care costs. However, after the markup, President Trump tweeted, “Thanks to Ways & Means and Education/Labor Committees for your work on Bills to protect patients and end medical bill ripoffs! Work with Energy & Commerce, HELP committees to send BIPARTISAN bill to my desk!”