The chair of the Senate health committee showed his support for the so-called "network matching" policy to end surprise medical bills, a proposal sharply opposed by specialty physician groups and the hospitals that employ them.
In a committee hearing on Tuesday, Sen. Lamar Alexander (R-Tenn.) said the policy, under which hospitals would have to guarantee to their patients that any doctor they see is in-network, is the one he "instinctively liked the best."
"It seemed to me, if the problem was out-of-network doctors, the solution would be to have in-network doctors," Alexander said. "That seemed to me the simplest solution to the problem. It also saves the most money."
After the hearing, Alexander declined to confirm whether it's the option that will end up in the final draft of the 165-page draft legislation, even as he announced that the committee will vote on the package next week.
"We'll see," he told reporters.
The debate over how Congress should end surprise bills is especially contentious in the Senate health committee, where two members have led a rival effort to pass a more provider-friendly arbitration model backed by specialty physician groups.
Sens. Bill Cassidy (R-La.), a physician, and Maggie Hassan (D-N.H.) both defended their own proposal, which triggers an arbitration process if out-of-network doctors or any other party aren't happy settling on a median in-network payment rate.
The health committee also included an arbitration policy, but its stricter limits haven't appeased specialty physicians who have been fighting hard for alternative proposals. Dr. Anthony Cirillo, who is lobbying on the issue for the specialty physician practice US Acute Care Solutions, characterized the panel's model as "sham arbitration" in a media call ahead of the hearing.
Cirillo and other specialty physician groups are pushing for the Cassidy bill in the Senate and a separate proposal from Reps. Raul Ruiz (D-Calif.) and Phil Roe (R-Tenn.), both physicians, in the House.
In addition to arbitration, the Senate health committee has also offered a payment benchmark model similar to the measure debated last week in the House Energy and Commerce Committee, which hospitals and specialty physician groups oppose.
On Tuesday, the American Hospital Association Executive Vice President Tom Nickels argued that a benchmark amounted to rate-setting and would ultimately resemble a single-payer system like Medicare for All.
But few Republicans appeared to buy that argument, including Sen. Mitt Romney of Utah, who said that "at first blush" he was concerned about the complexity of arbitration, adding that he believed a benchmark based on Medicare rates would be a simpler solution.
Sen. Mike Braun (R-Ind.) was also skeptical of Nickels' argument and said the industry needed to "wake up" or "Medicare for All will be the only alternative."
Senators spent less time on a provision that many insurers don't like, which would establish an all-payer claims database nationwide, although witnesses talked about how employers and states have been able to save millions of dollars once they knew how to get a handle on costs.
Sen. Tina Smith (D-Minn.) brought up the database in order to clarify that the final draft provision would let states maintain their own databases and also get access to the federal claims data, which would include employer-sponsored plan claims, when they need it.
The senators didn't discuss the bill's proposed contract reforms, bans on all-or-nothing clauses, or anti-tiering and anti-steering agreements, which hospitals hotly contest.
Sean Cavanaugh, chief administrative officer for the accountable care organization Aledade, said those contract reform provisions would have the most impact on out-of-pocket costs.
"If I had to quantify the magnitude, the ones that are specifically labeled pro-competition about particular hospital negotiating tactics, I think those will have the most direct and immediate," Cavanaugh said during the hearing.