The White House proposed a simple ban on surprise medical billing that left out controversial arbitration and payment benchmarking mechanisms during negotiations on Congress' third COVID-19 relief package, three sources familiar with the talks said.
All surprise billing measures were ultimately left out of the final economic stimulus package after fierce lobbying by healthcare providers. Reports of patients being balance billed for services related to COVID-19 are already emerging. The White House declined to comment.
The White House proposal would have limited beneficiary cost-sharing to in-network rates for out-of-network care at an in-network facility and for emergency care administered before a patient is stabilized, according to legislative text obtained by Modern Healthcare.
Providers that improperly balance billed patients would have been fined $10,000 if they did not withdraw the bill within 30 days and properly reimburse patients or insurers. However, the proposal would not have determined any further dispute resolution mechanism for out-of-network payments between providers and insurers.
Some providers are concerned that a simple ban on surprise bills could narrow insurance networks if plans don't have adequate incentive to go in-network, and choose to reimburse for services at a lower level out-of-network.
Balance billing by air ambulance providers would also have been banned. The ban would have phased out in December 2024 and would not have affected states with their own surprise billing laws.
Senate health committee Lamar Alexander (R-Tenn.), ranking member Patty Murray (D-Wash,) House Energy & Commerce Chair Frank Pallone (D-N.J.) and ranking member Greg Walden (R-Ore.) had pushed for their surprise billing measure based on median in-network payment benchmarks with a limited arbitration backstop to be included in the legislation.
Neither Senate Majority Leader Mitch McConnell (R-Ky.) nor Senate Minority Leader Chuck Schumer (D-N.Y.) have expressed enthusiasm for the bicameral, bipartisan compromise. Schumer called Murray to complain about the bill at a key juncture in December, and McConnell has said the proposal causes "internal divisions" in the Senate GOP.
A GOP spokesperson for the House Energy & Commerce Committee said their bill still has the best chance of becoming law.
"The White House has publicly — on multiple occasions — supported our bipartisan deal with Senate HELP. We are trying to end the practice of surprise billing patients. The administration has been pretty clear, stop Americans from getting ripped off," the spokesperson said.
However, the White House has backed off of its exclusive endorsement of the Alexander-Murray-Pallone-Walden bill, and instead said it broadly wants bipartisan legislation.
"Many excellent provisions are being considered on Capitol Hill and the White House remains in close contact with members as we work to move a solution forward that advances the president's priorities," White House spokesman Judd Deere said in a statement in February.
A surprise billing ban was excluded from all legislation introduced in Congress' third round of COVID-19 relief negotiations — even House Speaker Nancy Pelosi's (D-Calif.) stimulus bill only included an unenforceable suggestion that providers refrain from surprise billing.