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Senate panel approves health cost bill but plans changes

Sanders, Warren vote ‘no’ by proxy as they head to Democratic presidential debates

Chairman Sen. Lamar Alexander takes his seat for a Senate Health, Education, Labor and Pensions hearing this month. The panel on Wednesday approved a bill meant to lower health care costs. (Bill Clark/CQ Roll Call)
Chairman Sen. Lamar Alexander takes his seat for a Senate Health, Education, Labor and Pensions hearing this month. The panel on Wednesday approved a bill meant to lower health care costs. (Bill Clark/CQ Roll Call)

The Senate Health, Education, Labor and Pensions Committee on Wednesday approved, 20-3, legislation meant to lower health care costs, although senators suggested that more changes are likely before the floor debate next month.

Chairman Lamar Alexander of Tennessee hopes to bring the bill to the Senate floor for a vote in mid-to-late July, which will likely set up a flurry of lobbying and debate among lawmakers over changes to it.

Senate Majority Leader Mitch McConnell told CQ Roll Call that the package was on the priority list for floor time.

“We haven’t made a decision on exact timing yet, but it’s for early consideration,” the Kentucky Republican said.

Two of the three committee members who voted against the bill — Sens. Bernie Sanders and Elizabeth Warren — did so by proxy, likely because they are seeking the Democratic Party’s presidential nomination and participating in the Miami debates on Wednesday and Thursday. Kentucky Republican Sen. Rand Paul also opposed the bill.

Surprise medical bills are a frustration for consumers and a growing political issue. The legislation seeks to ban surprise medical bills by creating a benchmark rate for insurers to pay providers in certain cases when a patient unintentionally receives out-of-network care or does so in an emergency. That’s one area where the bill could change before it reaches the floor.

Several committee members are advocating for payers and providers to be allowed to use arbitration if they cannot reach an agreement on their own and raised concerns that the benchmark mechanism could have “unintended consequences,” particularly for rural providers.

The panel adopted by voice vote an amendment by GOP Sen. Bill Cassidy of Louisiana that would require insurers to tell patients if there are categories of providers in which the plan does not have any in-network providers for ancillary services that support doctors, such as radiology or lab work.

Cassidy said earlier in the markup that the current surprise billing language would put all the power in insurers’ hands and could disadvantage doctors or hospitals. He said Alexander pledged to work together on adjusting the bill before a floor vote.

“We took a step today toward moving in their direction by adopting the Cassidy amendment, and we’re going to keep working on that in the next three or four weeks,” Alexander told reporters after the markup. “There clearly are possibilities to continue to improve the bill and move in the direction that Senator Cassidy wants to go.”

Cassidy told CQ Roll Call that he would expect a compromise to include “at least a nod towards an independent dispute resolution or a third-party, like FAIR Health database,” a nonprofit database of billed insurance claims. If Congress opted for a similar database, an insurer could pay a certain percentage of the benchmark rate, he said, noting that Maryland has a framework like that.

“At least it gives an incentive to the insurance company to negotiate as opposed to not,” Cassidy said.

Cassidy also has an amendment, which he did not offer at Wednesday’s markup but could be an option later, to add an independent dispute resolution as a backstop. That independent dispute resolution mechanism would be available if the provider and insurer can’t reach an agreement on the benchmarked rate.

The measure also seeks to increase transparency on prices and spur more generic drug competition with a goal of lowering prescription drug costs.

The panel voted 16-7 to adopt an amendment from Wisconsin Democrat Tammy Baldwin and Indiana Republican Mike Braun that would require pharmaceutical companies to disclose certain information about a drug, such as the cost of its research and development and advertising funds, if the price of a drug over $100 climbs more than 10 percent in one year or 25 percent over three years.

Alexander opposed the amendment, but said he would continue to work with Baldwin before the bill reaches the floor to clarify the reporting requirements that drug companies would have to reach.

‘No’ votes

Alexander said at the outset of the markup that he hoped to avoid a fight over the 2010 health care law. Only Sen. Christopher S. Murphy offered an amendment related to the divisive law.

“I feel a little bit as if this committee is sometimes living in a fantasy world. I would argue that we should be spending our time trying to protect the Affordable Care Act,” the Connecticut Democrat said.

Murphy’s amendment, which was tabled by a vote of 12-11, would have required the administration to release a report detailing the effects of a lawsuit brought by Texas and other conservative states seeking to overturn the law.

“We have to start expecting that this lawsuit is going to be successful,” he said.

Warren said through a spokeswoman that she opposed the bill in part because it did not address the Trump administration’s approach to the health care law.

“I cannot vote for a bill claiming to lower health care costs that does not take meaningful steps to halt the administration’s shameful sabotage of health coverage for millions of Americans or hold drug companies accountable for soaring prices that force families to decide between medications they need and paying rent or putting food on the table,” Warren said through a spokeswoman.

Sanders did not vote for the measure because it would keep funding flat for federally qualified health centers and the National Health Service Corps, a spokesman said.

“This bill includes an absolute cut of nearly 20 percent in both programs,” the spokesman said. “At a time when people are already struggling to afford their health care and access providers in their communities, this was a real missed opportunity to help the most vulnerable people in our country.”

The committee also approved by voice vote two bills. One would affect the operation of a national toll-free phone number for poison control and promote education and poison prevention. The other would authorize $22.3 million annually for the Emergency Medical Services for Children Program between fiscal years 2020 and 2024.

Niels Lesniewski contributed to this story.

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