Lawmakers on the House Energy and Commerce health subcommittee appeared split on Wednesday over whether they should give physicians and hospitals a chance to appeal to an arbiter in a balance billing dispute.
The divisions over how to handle balance billing didn't fall along party lines and peeled both Democratic and GOP representatives from the committee leaders' bipartisan proposal to set a benchmark price according to the patient's in-network rate.
Committee Chair Rep. Frank Pallone (D-N.J.), who produced a draft policy with ranking member Greg Walden (R-Ore.), put his stake in the ground for transparency and price concerns.
"This debate has shed light on the fact that some providers' charges and hospital fees are inexplicably high, and I worry that if Congress chooses the wrong approach, consumers will simply end up paying those costs through higher premiums," Pallone said at the opening of the hearing. "We simply cannot allow this to happen."
But Rep. Raul Ruiz (D-Calif.) advocated for his own arbitration proposal that has not yet been introduced. Co-sponsors include a fellow committee member Rep. Larry Bucshon (R-Ind.), who argued during the hearing that providers need more negotiating power with insurers for higher rates.
This measure from Ruiz, Bucshon and the other co-sponsors is backed heavily by physician groups and would set up an arbitration model similar to the one hospitals and doctors use in New York and Texas.
Through questions to the witnesses, Rep. John Shimkus (R-Ill.) signaled he was open to arbitration while Rep. Doris Matsui (D-Calif.) questioned the benchmark rate.
Ruiz and physicians on the panel disputed the concern that introducing arbitration would add to costs or cause inflation of overall rates as employer groups, insurers and economists warn.
Other lawmakers were far more skeptical about the physician and hospital arguments, and pressured witnesses about transparency on prices and overall costs.
Claire McAndrew, of the patient advocacy group Families USA, described how certain physician staffing firms agree to join an insurance network only if they can bring in extremely high rates; she was responding to a claim from physician representatives that doctors want to enter network agreements.
Rep. Markwayne Mullin (R-Okla.) pressed American Hospital Association Executive Vice President Tom Nickels and Dr. Sherif Zaafran of Physicians for Fair Coverage about why they don't like a benchmark price. He described how he sets pricing for the jobs his business contracts for, and warned that if providers can't release basic cost data for treatments and procedures the government ought to.
"You can't tell me we don't have an average cost for what it takes to do as many surgeries as we do in this country, on as many parts of the body," Mullin said to Nickels. "You can't tell me we can't come up with an average cost on that."
When Nickels said that "in most instances we can," Mullin raised one hand and described how stitches for one finger he cut cost $11,000 at a Louisiana hospital. When he cut his thumb in Oklahoma, stitches were $150 at his local emergency department, he said.
Zaafran said the average weighted cost for every emergency visit was only about $155, and said his point was that the cost for an ED visit "is not as high as folks think it is."
"You can say whatever you want about your point," Mullin said. "The fact is bills that come through our mailboxes say (the costs) are very expensive."