The House Education & Labor Committee on Tuesday advanced legislation to ban surprise medical bills that closely resembles a bicameral compromise reached by two other committees in December.
The Ban Surprise Billing Act passed out of the Education & Labor Committee on a 32-13 vote with opposition from both parties. The vote leaves the House Ways & Means Committee as the lone dissenting voice advocating for an approach backed by hospitals and some physician specialty groups, with three other committees essentially united behind a proposal blending a benchmark payment with an arbitration backstop preferred by consumer groups and unions.
The Congressional Budget Office on Tuesday estimated that the Ways & Means proposal without a benchmark payment will save the federal government nearly $18 billion over 10 years. The CBO has not formally released a score of the compromise House Energy & Commerce-Senate health committee legislation, but the office estimates that surprise billing fix would save $24 billion over the 2020-2030 window, according to a CBO email sent to committee leaders.
An Education & Labor committee aide said the panel's bill is also expected to save the federal government around $24 billion over the next decade.
The Education & Labor Committee markup laid bare underlying conflicts over the role of an arbitration mechanism in protecting patients from surprise medical bills. Opposition to the bill did not break along party lines. Lawmakers shot down several attempts to make the legislation more provider-friendly by Reps. Phil Roe (R-Tenn.) and Joseph Morelle (D-N.Y.).
Morelle offered an amendment to replace the legislation with a bill proposed by leaders of the House Ways & Means Committee, which left out a benchmark payment mechanism and leans more heavily on an arbitration process. He withdrew his request after committee ranking member Virginia Foxx (R-N.C.) challenged the amendment on procedural grounds.
The White House said Tuesday that it was "concerned that a push to overuse arbitration will raise healthcare costs" and said it wanted a surprise billing fix to ban balance billing for air ambulances.
Education & Labor Committee Chair Bobby Scott (D-Va.) argued that if any amendments to move the bill to be more provider-friendly were adopted, the legislation would have lost the support of consumer groups and unions that backed their approach.
"I hope that we will accept a compromise with as much arbitration as these groups will stand," Scott said.
The Coalition Against Surprise Medical Billing, which is composed of insurers and employers, has not put their full-throated support behind the Education & Labor proposal because they are opposed to including any arbitration mechanism in surprise billing legislation.
Congressional Progressive Caucus Chair Pramila Jayapal (D-Wash.) reluctantly supported the Education & Labor legislation, but argued that including any arbitration mechanism in a surprise billing fix would add to the United States' already significant administrative cost burden.
"I believe arbitration adds in another layer of administrative costs to our healthcare system," Jayapal said.
Some lawmakers on both sides of the aisle worry that using a benchmark payment mechanism amounts to government rate-setting, even though the benchmark payment would be based on rates negotiated between providers and insurers.
"I firmly believe that the benchmarking, rate-setting model contained in this legislation today would have dramatic, harmful consequences for American patients, for America's hospitals and for our nation's healthcare system as a whole," said Morelle, a former state lawmaker in New York who voted against the Education & Labor surprise billing legislation.