Congress advances legislation against surprise medical billing

Brandon Paykamian • Updated Jun 27, 2019 at 11:37 PM

Legislation against surprise medical billing and high health care costs for patients is advancing in the U.S. House of Representatives and the Senate.

The Lower Health Care Costs Act passed the Senate Health Committee Wednesday by a 20-3 vote. Committee Chairman Sen. Lamar Alexander, R-Tennessee, said the legislation aims to end surprise medical billing, create more transparency with the medical billing process for patients and increase prescription drug competition through bipartisan provisions that aim to expand patient access to cheaper medications.

“Altogether, this legislation will help to lower the cost of health care, which has become a tax on family budgets and on businesses, on federal and state governments,” the senator said in a statement sent to the Press Wednesday.

The legislation approved Wednesday included two provisions added since the act’s introduction, including one that aims to raise the minimum age for purchasing any tobacco product from 18 to 21 and the CREATES Act, which “aims to help bring more low-cost generic drugs to patients by eliminating anti-competitive practices by brand drug makers.”

Alexander said he hopes the legislation will go to the full Senate next month for consideration and “would expect that other committees will have their own contributions” to the legislation. The senator said he and Committee Ranking Member Patty Murray, D-Washington, have been working with members of other committees on some of the legislation’s provisions. 

“The Senate Judiciary Committee is marking up bipartisan legislation on prescription drug costs tomorrow,” Alexander pointed out Wednesday. “And in the House, the Energy and Commerce, Ways and Means, and Judiciary Committees have all reported out bipartisan bills to lower the cost of prescription drugs.”

The Lower Health Care Costs Act is part of a larger, bipartisan push to lower costs and stop surprise billing in Washington, D.C.

On Wednesday, the Protecting People From Surprise Medical Bills Act — cosponsored by Reps. Phil Roe, R-Johnson City, Raul Ruiz, D-California, and six other representatives — was also introduced in the House. 

It aims to ban the practice of billing patients for unanticipated out-of-network care, improve transparency by requiring health plans to clearly identify in-network providers and patients’ deductibles and implement an arbitration model that “identifies a reasonable payment rate when insurers and providers cannot agree on the cost of care.”

“Our legislation is based on a proven, tested model from New York state, and I am confident that if enacted, this will prove helpful for patients, providers, insurers, employers and taxpayers,” Roe pointed out Wednesday.

On Thursday, Roe spoke with the Johnson City Press about the two pieces of legislation in the House and Senate. He said there are differences between the two bills that will need to be negotiated, but said Alexander's version of the bill "delves into drug pricing" issues more, while the House version mainly focuses solely on surprise billing.

However, the former physician said he opposed the Senate bill’s provisions on setting Medicare benchmarks, saying he thought it’d be unfair to Tennessee’s hospitals. He said that provision is good for California, where Medicare payments are much higher, but it hurts states like Tennessee, where payments are much lower.

“I don’t know how it will ultimately look, but stay tuned, because we’re going to have a really robust negotiation,” Roe said.

Ballad Health CEO Alan Levine agreed with Roe’s concerns about the benchmark provisions and supports Roe’s proposals for “baseball-style” negotiations where an arbitrator is involved.

“If anybody understands these issues better than they do, I don’t know who those people are, so I have a high degree of confidence in both Sen. Alexander and Congressman Roe that what they support will ultimately be something that is balanced and doesn’t harm doctors and hospitals,” Levine added. “Whatever action they take, I hope they understand that actions always have unintended consequences.”

While there are differences between the two pieces of legislation, Roe agrees with his colleagues in the Senate who have also emphasized the need for general transparency.

The congressman said the recent bipartisan cooperation in the legislature is “unheard of up here.” Roe said it’s easier to work together when legislators “find something everyone hates,” but said pushback from some insurance entities and lobbyists is to be expected.

“Any time you have any bill that involves money, there are going to be people lobbying you, there’s no question of that,” Roe said.