Senate Health, Education, Labor, and Pensions Chair Lamar Alexander (R-TN) is working with House Democrats to insert his controversial version of “surprise medical billing” legislation into the Medicare extenders package that must pass by the end of September, Capitol Hill sources tell RedState.
A Medicare extenders package is a bundle of small programs that require funding or updating to stabilize the program at large. They come up every year or two. Because Medicare extenders are “must-pass” legislation, some powerful politicians like to jam their bills into the package in order to avoid debate and up-or-down votes on flawed and stalled legislation.
Sources say Alexander is scheming with House Energy and Commerce Chair Frank Pallone (D-NJ) to execute the parliamentary maneuver with House Democrats to get the language of the Alexander legislation inserted into the Medicare extenders bill.
If Alexander and Pallone are successful, Conservatives in the Senate, who favor a more free-market approach to Alexander’s legislation, will be denied a clean vote on legislation to stop a practice President Donald Trump has called a “horrible injustice.”
Surprise medical billing, as David Williams of the Taxpayers Protection Alliance explains, “happens when a patient receives out-of-network care at an emergency room or hospital. The patient is later hit with the ‘surprise’ of sky-high bills for treatments and services they had assumed would be covered by insurance.”
The issue with Alexander’s Lower Health Care Costs Act is the fact that it allows the government to set reimbursement rates when insurance companies and healthcare providers have a billing or coverage dispute.
As Williams explains:
Legislation introduced in both the House of Representatives and the Senate would put in place a government-mandated benchmarking approach to settle payment disputes between insurers and physicians. On the surface, this may solve one problem by protecting patients from “surprise billing.” But this “solution” would merely give rise to an entirely new, and much more serious, set of problems that would seriously compromise medical care for patients nationwide.
Benchmarking would lead to government rate-setting and amount to price controls in which Washington, D.C. bureaucrats would be charged with determining and setting rates for physicians across the country. This would be a national healthcare nightmare.
Williams – and evidently a majority of Republican Senators – support a different proposal, Sen. Bill Cassidy’s (R-LA) “STOP Surprise Medical Billing Act”:
Instead, Congress should work to incorporate a market-based approach into legislation that addresses surprise billing issues. Fortunately, one such approach has already been outlined in the STOP Surprise Medical Bills Act, S. 1531. The legislation calls for an Independent Dispute Resolution (IDR) system that would empower doctors and insurers to negotiate openly, fairly, and transparently in order to resolve out-of-network payment disputes.
IDR is the only solution in Congress that has a winning track record. New York implemented a similar system back in 2015, and it has not only protected patients from “surprise billing,” but also helped increase network participation and decrease out-of-network rates and billing. All of that while keeping costs stable for care provided by emergency room doctors.
Alexander has been unwilling to negotiate with Senate Conservatives backing the IDR approach and has now turned to the Democrats to put together enough support to cram his bill in through the back door.
All parties involved should be commended for tackling the brutal practice of surprise billing. But Alexander’s bill is too friendly to insurance companies and puts the government in the driver’s seat. Alexander should sit down with Cassidy and other Conservatives to craft a plan that includes IDR.