Two lawmakers have banded together to whip members of a U.S. House of Representatives health panel to vote on an alternative policy to ban "surprise" medical bills.
The effort by Reps. Donna Shalala (D-Fla.) and Phil Roe (R-Tenn.) within the House Committee on Education and Labor focuses on a bill more generous to physicians and hospitals than legislation already approved by the House Energy and Commerce Committee. The move could further tangle the already contentious debate over how the feds should end the practice of balance billing. The issue of "surprise" medical bills is often instigated by specialty physician groups that contract with hospitals without joining their insurance networks.
Rep. Raul Ruiz (D-Calif.), an emergency physician, and Roe introduced the bill. Shalala, who headed HHS under President Bill Clinton, is a co-sponsor.
Shalala and Roe both said they are lobbying for their panel to hold the vote in September.
A senior committee aide pushed back on the idea the panel would take up the Ruiz-Roe bill.
"We do not comment on member to member meetings, but the committee will work from the two bipartisan proposals that have already moved out of House and Senate committees," the aide said, referring to legislation from the House Energy and Commerce and Senate HELP committees.
Shalala characterized her conversation with panel Chair Bobby Scott (D-Va.) as promising. She said he indicated he'd consider the alternative proposal if she and Roe can recruit enough support.
"He said, 'I'm going to let democracy prevail,' which means he's going to let us all have an opportunity to influence the bill," Shalala said.
The bill's more than 30 co-sponsors include other members of Scott's committee, such as Rep. Joseph Morelle (D-N.Y.) who helped craft his state's policy on which Ruiz and Roe based their measure.
The New York approach establishes an arbiter to resolve disputes between insurers and doctors or hospitals over payment for out-of-network treatment. The fall-back payment is median charges, which critics of the approach note aren't necessarily based on actual prices.
The Ruiz-Roe approach would set payment at a "commercially reasonable rate." It garnered endorsement of major specialty physician groups and criticisms of policy analysts.
Loren Adler, who has been working closely on the issue as associate director of the USC-Brookings Schaeffer Initiative for Health Policy, said this proposal's payment rate would reward physician staffing groups which he blames for escalating the problem.
"Not only would the Ruiz bill allow these staffing companies to keep the inflated rates they've generated through the threat of surprise billing, but it rewards them by doubling or tripling what they get paid," Adler said.
The push by Shalala and Roe show that the fraught debate within the provider world over a balance billing solution is only building in the vacuum left by congressional inaction. The Senate and House are heading out for a month-long recess without voting on a policy that President Donald Trump and lawmakers say is a high priority. This isn't for lack of a policy to vote on.
The House Energy and Commerce Committee just passed its legislation — staunchly opposed by hospital and physician groups — after Ruiz and other lawmakers brokered provider-friendly concessions, including an arbitration backstop for pay disputes in certain cases. Those compromises haven't ameliorated hospital and physician pressure.
The Senate health committee also advanced a proposal, which accompanied a slew of additional reforms to hospital payment and contracting practices.
But now comes to push from Shalala and Roe, even though observers of the debate originally thought that Scott's committee might waive its authority over the matter given the work of Energy and Commerce. The Education and Labor panel oversees employer insurance plans, and has a say on any federal solution to the balance billing issue within the commercial market.
Then there's also a new effort by the third major health committee in the House — Ways and Means. This could light a third front on the lobbying wars between insurers, hospitals and physician groups.
"Until something gets to the House floor and to the Senate floor, there are people who care deeply about this issue who will continue to talk about it," Ruiz said.
For Sen. Bill Cassidy (R-La.), who is pushing for changes to the health committee's legislation, the compromise secured by Ruiz on the Energy and Commerce bill isn't enough. He wants to let specialists like radiologists and pathologists to dispute the benchmark rates for lesser payment amounts.
And he hinted that he sees an opening for his fight in the impending August recess.
"Over the next 30 days senators and members of Congress returning home are going to hear from doctors and hospitals and others, regarding their concerns about the bill as currently constructed, about the need to have a safety valve in case the arrangements just are not what they should be," Cassidy said.
But Roe said that the additional proposals won't sink Congress' effort.
"I don't think that's going to happen," Roe said. "Here's what I think: I think the president wants it fixed, I think our constituents want it fixed, I think it's going to happen."
