House-Senate fix could break gridlock on ‘surprise’ medical bills


House-Senate fix could break gridlock on 'surprise' medical bills

Senate HELP Chairman Lamar Alexander (R-Tenn.), called for swift passage of the package, though it’s unclear whether there’s enough time in a legislative calendar already consumed with impeachment and year-end spending debates. Congressional aides said details of the legislation were forthcoming.

The top Democrat on Senate HELP Committee, Patty Murray notably hasn’t signed on to the deal — in a sign significant hurdles could remain.

“Senator Murray believes the overall agreement takes important steps forward on a number of issues impacting patients and families, and is working with some members of her caucus on concerns they still have,” wrote Helen Hare, a Murray aide, in an email.

The announcement comes as consumer advocates pushed for a solution that would hold patients harmless in billing disputes between health plans and providers. Congress set the issue as one of its top health care priorities this year, citing sometimes jaw dropping bills for care received out of network.

But while there was bipartisan desire to help consumers, nearly every health sector wanted somebody else to foot the bill when a patient inadvertently sees an out-of-network provider.

Both the Senate health and House Energy and Commerce panels approved legislation over the summer only to be confronted by a wave of attack ads over the August recess that slowed momentum for a final deal.

As outlined, the deal would also incorporate other unresolved health policy matters, by providing $20 billion over five years for community health centers. The package also addressed prescription drug costs with new measures to boost transparency and drug competition. It would also increase the age to buy tobacco to 21.

Provider groups strongly fought the way the Senate and House bills would have relied on setting a federal benchmark payment rate to settle billing disputes, arguing it would give insurers too much leverage and could lead to doctor shortages.

A dark money campaign poured nearly $30 million into spreading that message over the summer. The effort was ultimately revealed to be largely funded by two private-equity backed physician staffing companies.

Insurers and employer groups had cheered the benchmarking approach, but raised their own alarms about arbitration, contending it would be a handout to providers.

The possibility of including arbitration got a significant boost when a senior administration told POLITICO last week that the White House would be open to the option to after largely dismissing it in May.

Some rank-and-file members of the House Energy and Commerce Committee pushed hard for a way to settle disputes through outside arbitration, winning limited concessions that providers argued likely wouldn’t be used much.

Alexander had pledged to work with Sen. Bill Cassidy (R-La.), who led a bipartisan group of senators calling for a robust arbitration option, to potentially address some of the group’s concerns.

Lawmakers who allied with Cassidy said they appreciated the inclusion of arbitration in the House-Senate fix, but stopped short of endorsing the deal.

“As our discussions continue around the final details, we are encouraged that we’re one step closer to giving patients these vital protections,” Sens. Cassidy, Maggie Hassan (D-N.H.) and Michael Bennet (D-Colo.) said in a joint statement.

Joanne Kenen contributed to this report.


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