Skip to Main Content
Don't have an account? Create Account

On the Hill: Tackling Surprise Billing, Second Medicare for All Hearing

Before departing for a week-long Memorial Day recess, bipartisan leaders of the Senate Health, Education, Labor, and Pensions (HELP) Committee released draft legislation to fight rising health care costs and increase cost transparency.

The plan, released by committee Chair Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA), includes provisions to end balance billing, or surprise billing, practices for out-of-network emergency services; reduce prescription drug prices; and improve health care cost transparency, among other priorities. The committee seeks stakeholder feedback on three options to minimize surprise billing:

  • requiring out-of-network clinicians to bill health plans through the facility, instead of sending a separate bill to the patient or health plan. The provider and plan would have 30 days to resolve a payment dispute. If an agreement is not reached, the payment rate would be the median contracted rate for the service in the geographic area;
  • paying providers the median contracted rate within the geographic area for out-of-network services with a bill less than $750. For bills greater than $750, the provider or plan could choose to enter an independent dispute resolution process to determine the appropriate payment rate; or
  • paying providers the median contracted rate for services in the geographic area.

The HELP Committee intends to complete legislative proceedings on legislation to accomplish the goals in the draft plan before the July 4 recess.

The committee’s draft plan comes after bipartisan leaders of the House Committee on Energy and Commerce released draft legislation on surprise medical bills and a group of bipartisan senators introduced the Stopping the Outrageous Practice of (STOP) Surprise Medical Bills Act.

In addition, the House Committee on Ways and Means held a  May 21 hearing on surprise billing practices that featured testimony from two members of Congress, as well as hospital and insurance stakeholders. Witnesses stressed the need for federal legislation to protect patients from surprise medical bills and emphasized separating the patient from negotiations between hospitals and insurers.

House Hearing on Drug Transparency

Meanwhile, the House Committee on Energy and Commerce held a May 21 hearing on seven House bills to increase transparency of prescription drug price increases. The hearing included testimony from several drug manufacturers and patient advocacy groups. Witnesses and committee members agreed on the need for transparency within the drug pricing industry, but would not specifically address high drug costs. Some of the witnesses voiced concern that requiring manufacturers to make data public could undermine the intent of decreasing prices and could lead to anti-competitive behavior.

Second Medicare for All Hearing

The House Committee on the Budget last week held a second congressional hearing on transitioning to a single-payer system.

Senior analysts from the Congressional Budget Office (CBO) testified that transitioning to such a system would result in more coverage, but also could prove “disruptive” and “increase government control” over the heath care system. The CBO analysts added that increased coverage coupled with decreased payment rates for physicians and hospitals could reduce the supply of health care services and affect access to care.

The House Committee on Rules last month held the first congressional hearing on a single-payer system, focusing on Rep. Pramila Jayapal’s (D-WA) Medicare for All proposal. Earlier this month, CBO released a report on key design components and considerations for lawmakers on transitioning to a single-payer health care system.

Share

About the Author

Erin Delaney is the legislative affairs associate at America's Essential Hospitals.

Previous Next
Close
Test Caption
Test Description goes like this