Senate panel makes surprisingly fast work of ‘surprise medical bills’ package

Reviewed by Kate Anderton, B.Sc. (Editor)Jun 26 2019

It may seem as if the Senate, or at least certain key senators, have decided on a way forward to fix the nation's "surprise medical bill" problem. But make no mistake: The door is still open to try another solution.

Members of the Health, Education, Labor and Pensions (HELP) Committee approved a sweeping measure Wednesday that tackles a range of big-ticket health care concerns. The 196-page bill touches nearly every aspect of the health care industry, from lowering the price of prescription drugs and creating a national database of health care costs, to increasing vaccine rates and preventing youth tobacco use.

One thing the bill specifically does not deal with: the insurance market and the Affordable Care Act, which could be why the massive package was voted out of the committee in just over two hours with little debate. The Lower Health Care Costs Act of 2019, sponsored by HELP Committee Chairman Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the top Democrat on the panel, sailed through with a bipartisan 20-3 vote.

"You don't have to preach the whole Bible in one sermon," said Alexander as he described his panel's action. "We picked out one important thing: reducing health care costs."

Still, just because the first hurdle has been cleared doesn't mean there's room for speculation about what could happen between now and when it reaches the Senate floor. Alexander said he's hoping the bill will be voted on before the Senate leaves Aug. 2 for a monthlong recess.

The smooth hearing capped a busy few weeks, as senators debated the mechanism that would be used to stop surprise medical bills — the unexpected and often costly charges patients face when they get care from a doctor or hospital not in their insurance network.

An earlier draft of the bill outlined three options to solve disputes between payers and providers. There was an in-network guarantee, where all of the health care providers at a hospital — whether the anesthesiologist or lab — must accept in-network insurance rates.

Another option, often referred to as baseball-style arbitration, would have the health plan and the doctor — if they couldn't reach an agreement on reimbursement — present to an independent arbitrator their best offers for how much a patient's out-of-network care should cost. The arbitrator would choose between the two.

But another approach — benchmarking — ultimately made it into the formal draft. Here's how it works: When patients are seen by doctors who aren't in their network, the insurer would pay the providers the "median in-network rate," meaning the rate would be similar to what the plan pays other doctors in the area for the same procedure.

At the markup hearing Wednesday, Alexander said he initially preferred one of the other approaches, the in-network guarantee, but changed his mind when the Congressional Budget Office said benchmarking would save more money.

A group of senators on the panel led by Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.) and Lisa Murkowski (R-Alaska) voted for the chairman's choice, even though they had advocated for arbitration. Cassidy made clear he continues to have reservations.

"This is entirely for the insurance companies," he said of benchmarking. "I'm surprised that my colleagues on the other side of the aisle running for president are OK with this."

Neither of the two Democratic senators on the committee running for president, Sens. Elizabeth Warren (Mass.) and Bernie Sanders (Vermont), were present but both voted no by proxy.

But it is also not an entirely settled issue.

Cassidy and Alexander indicated that the door was still open to including independent arbitration before the package gets to the floor.

"We're going to keep working on that the next three or four weeks. There are clearly opportunities to improve the bill and move in the direction Sen. Cassidy wants to go," Alexander told reporters after the hearing.

At the markup hearing Wednesday, the committee took a step toward Cassidy's preferred vision for fixing surprise bills. It passed an amendment from Cassidy that would require insurance companies to post accurate lists of who is in-network, so patients have a better chance of avoiding surprise bills.

"This bill is not as good as it should be," Cassidy said. "And I thank the chairman because he has offered to work between now and floor consideration on the surprise bills."

The only other amendment approved by the panel, offered by Sen. Tammy Baldwin (D-Wis.), would require drug companies to report price increases.

And despite Alexander saying early on that he didn't want to talk about the individual insurance market or the ACA, some Democrats couldn't let the opportunity pass without mentioning Republican efforts to undermine it.

"Repairing the train can only get you so far if you are pulling up the track at the same time — and that's unfortunately exactly what this administration is doing," Murray said in her opening statement. "The biggest threat to families' health care continues to be sabotage from President Trump."