Two House committees on Friday released proposals to curb surprise medical bills, setting up action soon on a potent political issue that frustrates consumers.
The Ways and Means Committee and the Education and Labor Committee plan to vote on their bills next week, following the Energy and Commerce Committee, which approved its own plan last year.
Protecting patients from surprise out-of-network medical bills is a goal for Democrats, Republicans and President Donald Trump, but reaching agreement has proven more difficult than many initially expected.
Lawmakers hope to include surprise billing legislation in a package that would extend funding for public health programs that expire on May 22. House lawmakers appear eager to move forward quickly, but members are torn over the best way to handle payment disputes. The tensions could become more evident next week.
The Ways and Means Committee draft bill released Friday proposes that when a patient receives a surprise bill for out-of-network medical care at an in-network facility or when receiving emergency care, providers and insurers would negotiate payment through a dispute resolution process.
Both sides would first have 30 days to negotiate payment on their own, during which they would be required to share some information about payments to facilitate an agreement. If the sides still disagree, either party could initiate a 30-day arbitration process, in which both sides would propose their last, best offer to an independent mediator.
There would be no minimum charge amount needed for either side to seek an arbitration agreement, but the mediator would not be allowed to consider a provider's "usual charges" in determining the payment.
The draft also would require health insurers to tell patients the expected charges for a procedure at least three days before it is scheduled.
The committee's draft bill would not directly address surprise bills received by patients who take air ambulance rides, but would require providers to share cost data and insurers to share claims data to the Department of Health and Human Services.
The measure would take effect beginning in 2022.
"Our bipartisan approach differs from other proposals in that we require — for the first time — that patients receive a true and honest bill in advance of scheduled procedures and we create a more balanced negotiation process to encourage all parties to resolve their reimbursement differences before using the streamlined and fair dispute resolution process," Chairman Richard E. Neal, D-Mass., and ranking member Rep. Kevin Brady, R-Texas, said in a joint statement.
Neal has indicated he wants to mark up the bill Wednesday.
The Education and Labor Committee released its own competing proposal later Friday and said it will mark up its bill on Tuesday.
Under its proposal, insurers would pay out-of-network providers the median in-network rate for that geographic area for amounts up to $750. For larger amounts, either side could request an arbitration process. When a patient receives a surprise bill from an air ambulance provider, the threshold would be $25,000.
The proposal puts the panel largely in line with what the Energy and Commerce and the Senate Health, Education, Labor and Pensions committees proposed in December, after they changed bills they approved earlier in the year.
The Education and Labor proposal is already receiving resistance from at least one committee member. Rep. Donna E. Shalala, D-Fla., a former Health and Human Services secretary, told reporters she would vote against the measure in committee if it is not amended.
“I have problems with it because it's not balanced,” Shalala said. “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.”
Shalala said she expected her staff would work on proposed amendments this week and talk with other committee members about possible proposals. She added that she plans to sign on to the Ways and Means measure, which she called “very imaginative,” and said mirrored an approach she and Rep. Joseph D. Morelle, D-N.Y., had urged Education and Labor Committee leaders to take up.
Energy and Commerce Chairman Frank Pallone Jr. told reporters that he thought a final measure should set a benchmark payment rate, but he said he wasn’t “insisting on anything at this point,” other than achieving enough savings to fund a five-year extension of public health programs, like community health centers.
“We're going to work with the other committees and come up with a solution,” Pallone told reporters Friday. “The most important thing is that we have surprise billing and that we have this package where the savings pay for the health care extenders.”
Pallone joined with Energy and Commerce ranking member Greg Walden, R-Ore., HELP Committee Chairman Lamar Alexander, R-Tenn., and ranking member Sen. Patty Murray, D-Wash., in a statement that avoided criticism of the rival approach that Ways and Means is considering.
"Protecting innocent patients has been our top goal throughout this effort, and we appreciate that the other two House committees share this priority," said the joint statement. "We look forward to working together to deliver a bill to the president's desk that protects patients and lowers health care costs."
More lawmakers appear to be getting involved in the issue. The Congressional Progressive Caucus discussed the issue in a meeting Thursday.
"We think the Pallone bill is the closest to what we would want to support and we have concerns about weakening that because we really do think that this is a critical issue and we need to keep it as strong as possible," Rep. Pramila Jayapal, D-Wash., one of the group's co-chairs, told reporters.
The fight over payment has so far been the subject of intense lobbying, but lawmakers say they hope they can reach a deal soon.
"For most of us though, the details are important but bigger is just that we can't get caught up too much in any of the nuances," Ways and Means committee member Dan Kildee, D-Mich., told CQ Roll Call this week. "We’ve got to get something done."