Lawmakers may add surprise billing plan to virus response bill

Ending surprise out-of-network medical bills has been a bipartisan priority

Sen. Bill Cassidy, R-La., a member of the health task force working on the third phase of COVID-19-related legislation, is working to include surprise billing in the package. (Bill Clark/CQ Roll Call)
Sen. Bill Cassidy, R-La., a member of the health task force working on the third phase of COVID-19-related legislation, is working to include surprise billing in the package. (Bill Clark/CQ Roll Call)
Posted March 19, 2020 at 12:49pm

Some lawmakers are pushing to include language to prohibit surprise medical bills in the third legislative package responding to COVID-19.

The move comes as lawmakers write a $1 trillion measure to respond to the health care and economic effects of the pandemic that has essentially shut down several industries across the country.

Ending so-called surprise out-of-network medical bills has been a bipartisan priority since last year, but industry groups disagree on how to determine payment disputes and squabbles between committees have slowed down an effort to bring legislation to the floor of either chamber. 

Three House committees and one Senate panel have marked up bills that would ban health care providers from sending surprise bills to patients who have health insurance but are unexpectedly treated by an out-of-network provider, either in the case of an emergency or by an out-of-network provider at an in-network facility. 

Three panels — Energy and Commerce, the Education and Labor and the HELP committees — have similar bills that allow for arbitration only in some cases when payment disputes between insurers and medical providers continue, while the Ways and Means Committee would focus on arbitration.

The Congressional Budget Office projected that the proposals being considered in Congress could save between $17.8 billion and $24 billion over 10 years. The Energy and Commerce and the Health, Education, Labor and Pensions committees have proposed using those funds to provide long-term funding for community health centers.

"There is no reason to make our CHCs lurch from funding deadline to funding deadline. They are on the front lines of the fight against COVID-19. They need to be funded. They need that certainty," Zack Roday, a spokesman for Energy and Commerce Committee ranking member Rep. Greg Walden, R-Ore., said in an email. "We can fund CHCs – fully for 5 years if we package this with our bipartisan, bicameral deal to end surprise medical billing."

Steve Carey, the chief strategy officer for the National Association of Community Health Centers, said community health centers across the country are looking for their regular funding to be extended as well as $3.2 billion to respond to the coronavirus pandemic. That would serve as a much-needed morale boost as providers are on the front lines of treating COVID-19 patients.

"These people are caring for patients from their own community and they're expected to do more, and then they're reading that Congress and the administration is looking to bail out airline industries. You can imagine the impact," Carey said.

"When you see that there are industries getting bailouts, we're not even looking for bailouts,” he added. “We're looking to be made whole."

Cole Avery, a spokesman for Louisiana Republican Sen. Bill Cassidy, confirmed his boss is working to include surprise billing in a package. Cassidy is a member of the health task force working on the third phase of COVID-19-related legislation.

The main dispute on surprise billing centers on what type of mechanism to use to determine how health insurers should reimburse providers for unexpected out-of-network care. Health insurance companies and employer groups have urged lawmakers to set a benchmark payment rate, while doctors and hospitals are recommending that both parties enter in an arbitration agreement.

The Energy and Commerce, the Education and Labor and the HELP committees have proposed setting a benchmark payment and allowing either party to request arbitration when the costs are above a certain threshold. The Ways and Means Committee has proposed giving both parties 30 days to reach a resolution on their own and then using arbitration to resolve payment disputes.

The SOAR Campaign — a group representing the air ambulance industry, which has some of the most expensive surprise bills — said in a Wednesday statement that it opposed efforts by the Energy and Commerce and HELP committees to include their proposal in a COVID-19 response package.

"As the nation copes with the impact of the global COVID-19 pandemic, policymakers must remain focused on protecting access to emergency medical care – particularly for our most vulnerable populations – rather than impeding it," the statement said.

Conservative groups also warned against including surprise billing language in a legislative package.

"It's a time for targeted, temporary, science-backed solutions to deal with containing the coronavirus and helping those directly harmed by its economic consequences," Jason Pye, vice president of legislative affairs at FreedomWorks, said. "A federal, top-down mandate to 'fix' surprise billing is likely to cause as many new problems as it solves, likely leading to shortages of care that will last long after we've beaten back the pandemic."