The House Ways & Means Committee on Wednesday advanced a bill that would ban balance billing using an arbitration process favored by hospitals and specialty physician groups but opposed by insurers, employers and labor unions.
The Ways & Means Committee is the last of three House panels with jurisdiction over surprise billing to mark up legislation addressing the issue, which lawmakers are aiming to resolve before a deadline to fund expiring Medicare and Medicaid programs on May 22.
The other two House committees and the primary Senate committee responsible for the issue have coalesced around a different approach that blends a benchmark payment rate and a more limited arbitration process.
Ways & Means Chair Richard Neal (D-Mass.) said the process of merging the two approaches would likely begin with reaching a consensus in the House.
"We think that we have a bridge to a solution with the Senate. There's going to be some give and take. I assume that we will begin to try to reconcile the differences almost immediately," Neal said.
The Congressional Budget Office estimated that the arbitration-only approach would save the federal government $17.8 billion over 10 years that lawmakers could use to pay for other priorities. While the CBO has not released a formal score of the blended benchmark-arbitration approach, relevant committee leaders were informed it is expected to save around $24 billion.
The Ways & Means Committee bill passed out of the panel overwhelmingly, though lawmakers did not take a recorded vote on the proposal.
Hospitals and providers have largely coalesced around the Ways & Means proposal. The American Hospital Association, Federation of American Hospitals, America's Essential Hospitals, American Medical Association, Greater New York Hospital Association, American Society of Anesthesiologists, American College of Surgeons, American College of Emergency Physicians and Association of American Medical Colleges released statements supporting an arbitration-only approach. However, several stakeholders expressed concern that the arbitrator would be required to consider in-network median payments.
"We support the underlying mechanism for resolving these disputes, including the eligibility of all disputed claims for negotiation and mediation," AMA President Dr. Patrice Harris said.
The Ways & Means bill would require data collection on air ambulance balance billing practices but would not ban surprise medical bills, unlike the other committees' legislation. That approach garnered the support of the Save Our Air Medical Resources coalition, whose members include major air ambulance providers and the air ambulance lobby.
But the arbitration-only approach has drawn spirited opposition from insurers, employers, and labor unions. America's Health Insurance Plans, the Unite Here labor union, the Coalition Against Surprise Medical Billing, the Pacific Business Group on Health and Families USA criticized the absence of a benchmark payment rate in the Ways & Means legislation.
"The proposal by Ways & Means of an 'independent mediated negotiation process' is simply thinly veiled arbitration that will protect the interests of profit at the expense of patients and employers," Pacific Business Group on Health President and CEO Elizabeth Mitchell said in a statement.
The White House also voiced skepticism about an arbitration-only approach on Tuesday. Spokesman Judd Deere said the White House "is concerned that a push to overuse arbitration will raise healthcare costs" and wants final legislation to ban balance billing for air ambulance transports.
Several patient advocacy groups have remained neutral so far. AARP and several disease-specific advocacy groups have generally voiced support for protecting consumers, but have not put their weight exclusively behind one proposal.
The Ways & Means committee also advanced bills Wednesday that would give HHS more authority to oversee and penalize hospices for health and safety issues and require transparency for private equity investments related to healthcare providers. Republicans opposed the private equity transparency measure because they viewed it as targeting private equity while ignoring other merger and acquisition issues in healthcare.
The Congressional Progressive Caucus, an important faction of House Democrats, have indicated that members are concerned about the role of private equity in surprise medical billing. The House Education & Labor Committee added to its surprise billing proposal a private equity transparency provision that would require the Comptroller General of the United States to issue a report on the relationships between private equity firms and providers that use their more limited arbitration process.