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.
