Rachel Cohrs December 04, 2019
Members of the
House Education & Labor Committee are shifting gears to explore a
provider-friendly solution to surprise medical billing.
Reps. Joe
Morelle, (D-N.Y.), Donna Shalala (D-Fla.), Phil Roe (R-Tenn.) and Van Taylor
(R-Texas) are circulating a letter obtained by Modern
Healthcare asking their House colleagues to support surprise billing
legislation including an independent dispute resolution process, an approach
supported by providers. The Education & Labor Committee shares jurisdiction
over surprise billing.
"Instituting
a neutral, independent review process after direct negotiations between the
parties can lower healthcare costs without massive disruptions to the
healthcare market," the letter reads.
The White House
has recently signaled it may support a surprise billing fix that includes an
arbitration process.
However, the No
Surprises consumer advocacy campaign, which is spearheaded by Families USA,
argues there is no evidence that a payment system based on a benchmark of
negotiated in-network rates harms network adequacy.
A House bill
including a baseball-style arbitration process that referenced provider charges
fizzled after a preliminary score by the Congressional Budget Office estimated
that it would have cost the federal government money and increased premiums.
Morelle said he is interested in pivoting to instead use a median in-network payment
rate in an arbitration process to improve the bill's CBO score.
"We
concluded that we are not going to be able to move people unless we get
savings," Morelle said on Wednesday.
The House Energy
& Commerce version of surprise billing legislation includes an arbitration
backstop, but Morelle said he thinks its arbitration threshold is too limiting.
The White House
signaled it may be open to including some sort of arbitration process in a
surprise billing fix, but also that savings will be important. A senior
administration official told Politico on Tuesday that the White House may be
open to arbitration depending on guardrails on the process. Hospital and
specialty physician groups argue that a benchmark payment system
gives insurers too much leverage.
However, the
official also said that savings would be a factor in what surprise billing
legislation the White House might support. The CBO estimated that the Senate
health committee's provision and the House Energy & Commerce version would
both save more than $20 billion over 10 years.
Sens. Bill
Cassidy (R-La.) and Maggie Hassan (D-N.H.) claimed Wednesday that the
official's comments signaled that the White House is open to legislation
similar to a provider-friendly bill they have pushed that would give doctors
the option to challenge a median in-network payment rate to an independent
arbiter. Their bill is estimated to save around $17 billion.
With less than
three weeks until lawmakers' deadline to fund the government on Dec. 20, the No
Surprises campaign is concerned that adding another proposal into the already
chaotic landscape of surprise billing legislation could undermine bipartisan,
bicameral negotiations underway between Senate health committee Chair Lamar
Alexander (R-Tenn.), Ranking Member Patty Murray (D-Wash.), House Energy &
Commerce Committee Chair Frank Pallone (D-N.J.) and Ranking Member Greg Walden
(R-Ore.). The House Ways & Means Committee is also exploring developing its own
legislation.
Rep. Daniel
Lipinski (D-Ill.) is circulating a letter of his own asking his colleagues to
act on surprise billing legislation by the end of the year.
"Please join
me in sending a letter to House and Senate leadership urging action on this
critical issue in any year-end legislation," Lipinski wrote.
Editor's Note: A previous version of this story
incorrectly stated that Rep. Phil Roe (R-Tenn.) is not a member of the House
Education & Labor Committee. We regret the error.
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