Republican senators in competitive re-election races have quietly moved toward supporting a provider-friendly surprise billing proposal that appeared to have stalled.
As a May 22 deadline to fund expiring healthcare programs gets closer, several vulnerable GOP senators have announced their support for a surprise billing proposal pushed by Sen. Bill Cassidy (R-La.) that has been shelved by committee leadership.
Sens. Martha McSally (R-Ariz.) and John Cornyn (R-Texas) announced their support for Cassidy's bill on Feb. 11, and Sen. Thom Tillis (R-N.C.) followed suit on March 3.
Tillis said he thought some portions of a bipartisan compromise bill between Senate health committee Chair Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.) "went too far," and that he thinks Cassidy's legislation has a better chance of passing.
"As we're moving forward and looking at opportunities to have it ride on some vehicle that may get passed out, I thought it was important to voice my support for it," Tillis said.
Cassidy's bill includes a median benchmark payment and a baseball-style arbitration process to resolve disputes. Cassidy's office said the legislation would save the federal government between $17 billion and $18 billion compared with $24 billion for the Alexander-Murray compromise with House committee leaders. Providers like the arbitration mechanism in Cassidy's bill because the arbitrator would be allowed to consider prior negotiated rates.
Cassidy pointed out that several lawmakers have holds on the Alexander-Murray legislation and that his bill took two years of stakeholder drafting to compile.
"The longer you live with it, the more you know that it's an issue. It was maybe that no one had yet pigeonholed their senators saying this is a problem, but once you hear the story you understand it's a problem," Cassidy said.
Alexander's office did not respond to an inquiry about how many legislative holds remain. However, Senate Majority Leader Mitch McConnell (R-Ky.) noted on Feb. 11 that there are "internal divisions within my party in the Senate" on the Alexander-Murray legislation.
GOP Sens. Joni Ernst of Iowa, David Perdue of Georgia, and Cindy Hyde-Smith of Mississippi are also running for re-election and have endorsed Cassidy's legislation, though Ernst also supports the Alexander-Murray proposal. Sen. Susan Collins (R-Maine) voted for the Alexander-Murray legislation in committee and her office did not respond to an inquiry about her position on Cassidy's bill.
The private equity-backed group Doctor Patient Unity has run television and radio ads in some of the states where senators have decided to support Cassidy's approach. The group has spent nearly $321,000 in Arizona, $172,500 in North Carolina, $52,000 in Texas, $211,800 in Louisiana and $91,000 in Colorado so far in 2020. Sen. Cory Gardner (R-Colo.) has not taken a position on one bill over another.
"This is an issue that we have to address and we have got to make sure that we get these policies right," Gardner said.
Meanwhile, House Democrats are still trying to sort out a compromise between two competing proposals. Nineteen physician groups on Wednesday sent a letter to congressional leaders in support of the broad strokes of provider-friendly bill out of the Ways & Means Committee that does not include a benchmark payments, and would instead resolve payment disputes through a negotiation and arbitration process.
The physician groups asked that criteria that could be considered an arbitration process be more similar to those proposed in Cassidy's bill, though that change could significantly affect federal savings.
The Republican Study Committee also released a white paper on surprise billing that bashed both leading proposals in the House and instead suggested transparency measures. Both leading House proposals also have provisions that would increase transparency for consumers by requiring some cost estimates before service delivery and updated provider directories.