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Congress split over how to solve surprise medical bills

Posted February 7, 2020 5:11 p.m. EST

— Protecting patients from surprise medical bills is one thing that lawmakers in Congress agree on. But they aren't united on how to solve the problem.

The path to fixing surprise medical bills got more complicated Friday, when two more House committees released proposals -- just days after President Donald Trump reiterated his call for Congress to address this issue in his State of the Union address.

These new efforts join a bipartisan deal hammered out by leaders of the House Energy & Commerce and Senate Health committees in December.

At issue are the bills that patients get after receiving care from out-of-network physicians or hospitals, often in an emergency situation. These unexpected charges are one of Americans' top health care headaches. Roughly 1 in every 6 emergency room or in-hospital stays generated at least one out-of-network medical bill in 2017, according to a Kaiser Family Foundation analysis.

While the matter is one of the few to enjoy broad cross-party support on Capitol Hill and in the White House, just how to spare Americans from unexpected bills became bogged down last year amid a lobbying and advertising blitz by the health care industry.

All the bills protect patients, who would pay the same amount they would have if the providers were in-network.

But who covers the rest of the tab is in dispute. Insurers favor the government setting a benchmark rate, but hospitals and other providers -- often backed by private equity firms -- strongly support resolving the matter through arbitration.

The bill released Friday by House Ways & Means Committee leaders calls for insurers and providers to settle their dispute through arbitration if a 30-day negotiation period fails. It would also require that patients receive in advance of treatment an explanation of benefits, which would include a cost estimate and the network status of providers.

Meanwhile, the Committee of Education and Labor unveiled a bill that would require insurers to pay the market-based, median in-network rate for amounts up to $750. For larger charges, providers and insurers could turn to arbitration.

The latter bill is similar to the bipartisan, bicameral deal announced in December by House Energy & Commerce Committee Chair Frank Pallone, Democrat of New Jersey, and Ranking Member Greg Walden, Republican of Oregon, and by Senate Health Committee Chair Lamar Alexander, Republican of Tennessee, and Ranking Member Patty Murray, Democrat of Washington. Each of those committees passed the legislation last year.

"Protecting innocent patients has been our top goal throughout this effort, and we appreciate that the other two House committees share this priority," the lawmakers said in a 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 for American consumers."

The two new bills will be considered by their respective committees next week. Lawmakers are hoping to pass the legislation by the end of May, when the funding for certain public health measures must be extended.

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