A bipartisan push for legislation to protect patients from massive “surprise” medical bills is facing a buzzsaw of opposition from doctors and hospitals and reservations from some Democrats worried about delivering President Trump a health care victory when he is still attacking ObamaCare.
The surprise billing measure has support from bipartisan committee leaders in both the House and Senate, patient advocates and insurers — and was moving forward quickly before Congress left town for August. It was seen as one of the most promising avenues for lawmakers to target health costs this year.
But those efforts are stalling amid a fierce lobbying blitz and political pressures as the 2020 elections nears.
Doctors groups are running millions of dollars in ads against the effort. And some leading Democrats have objected to moving on the issue now, wary of giving Trump and Republicans a win on health care. They say the focus should be on what they say is the GOP “sabotage” of ObamaCare. And Republicans have grown cautious about holding another health care debate as Democrats hit them over the issue of pre-existing conditions.
There are still powerful committee chairmen backing the effort, which would protect patients from getting massive bills when they go to the emergency room and only later discover that one of the doctors who cared for them was not in their insurance network.
A measure led by Sens. Lamar Alexander (R-Tenn.) and Patty Murray(D-Wash.) advanced out of the Senate Health Committee in June on a large bipartisan vote, and a similar measure from Reps. Frank Pallone Jr. (D-N.J.) and Greg Walden (R-Ore.) advanced from the House Energy and Commerce Committee in July.
Powerful doctor and hospital groups are stepping up their opposition to those measures, warning that they would result in damaging cuts in payments to doctors.
“Big insurance companies want a one-size-fits-all approach that lets them decide what they’ll pay doctors for your care,” warns an ad launched by the group Physicians for Fair Coverage against the effort.
A separate group, called Doctor Patient Unity, which does not disclose its donors, has spent at least $10 million on ads opposing the effort, according to the Center for Responsive Politics.
Doctors also mobilized to lobby lawmakers and their staff against the effort over the August break.
Doctors and hospitals say they agree that patients should be protected from surprise medical bills and insist they are only objecting to how the current legislation addresses that issue, by effectively setting a price that insurers will pay doctors.
But congressional aides backing the legislation say they think the doctor and hospital groups are really trying to kill the entire effort and protect a status quo that allows them to bill patients exorbitant amounts.
A congressional aide said there has been an “onslaught” from those groups “moving towards just trying to kill this.” While advocates once expressed optimism that legislation could reach Trump’s desk, the aide now said it is “premature” to say if legislation will pass.
Passing any health care legislation is challenging given the charged politics of the issue.
Congressional Republicans have seized on surprise billing as a way to rack up a bipartisan health care win and get away from their previous efforts to repeal ObamaCare, which opened them up to effective attacks from Democrats in the 2018 midterm elections.
Across the aisle, some Democrats are wary of allowing Republicans to claim victory on a bipartisan health care achievement when they are still supporting a lawsuit making its way through the courts that seeks to overturn the entire Affordable Care Act.
“I do feel a little bit as if we are applying as a government a bandage to a cut on one arm while we are sawing off the patient’s other arm,” said Sen. Chris Murphy (D-Conn.) in June, when he threatened to vote against the surprise medical billing legislation if it didn’t include measures to fight GOP “sabotage” of ObamaCare, a clear non-starter for Republicans.
Sen. Elizabeth Warren (D-Mass.), one of the party’s top-tier candidates for president, voted against the surprise billing legislation in committee in June, saying that she could not vote for a bill that does not address “the administration’s shameful sabotage of health coverage for millions of Americans.”
As the presidential campaign heats up, bipartisan action on health care will be even harder to find.
Senate Democrats have already said they will demand votes on politically charged health care amendments if a different health care bill, aimed at lowering drug prices, comes to the floor, illustrating their desire not to give Republicans an easy vote on any health care accomplishment.
In addition, Senate Democratic Leader Charles Schumer (N.Y.) is facing pressure from hospitals in his home state. The Greater New York Hospital Association (GNYHA), one of the leading opponents of the current surprise billing legislation, told The Hill it had personally lobbied Schumer, as well as his staff, against the measure.
“I think he does understand our perspective, [but] he has a big caucus,” said Jon Cooper, senior vice president for government affairs at the GNYHA.
Schumer’s office did not respond to a request for comment on whether he supports the Senate Health Committee legislation.
It is also unclear if Senate Majority Leader Mitch McConnell (R-Ky.) would allow a floor vote.
Hospital groups say they would support surprise billing legislation if it used a different mechanism, allowing an outside arbiter to help resolve disputes between hospitals and insurers over payment.
But some experts warn the approach advocated by doctors and hospitals would drive costs up, not down.
Loren Adler, a health policy expert at the Brookings Institution, said approaches pushed by provider groups would be “rewarding [doctors] for exploiting the system for so long by giving them even more money.”
Adding to the delays, three different committees in the lower chamber are jockeying with each other to be the one to address the issue. In addition to the legislation already passed out of the House Energy and Commerce Committee, the House Ways and Means Committee and the House Education and Labor Committee are both working on their own legislation.
Sources say they expect the Ways and Means legislation in particular will be more friendly to doctors and hospitals than the Energy and Commerce legislation is.
In the upper chamber, Alexander has been in talks with Sen. Bill Cassidy (R-La.) about a potential modification to the measure to help address doctors’ concerns, though no deal has been reached yet.
“I definitely think that the doctors and the hospitals and other providers are having an impact because I hear from my colleagues that they heard from folks back home,” said Rep. Joe Morelle (D-N.Y.), a member of the Education and Labor Committee who is pushing for an alternative bill viewed more favorably by providers.
Morelle said he does not want fears over giving Trump and Republicans a bipartisan health care accomplishment to get in the way of good policy, though.
“I’m happy to give the president that win if it means that families are protected,” Morelle said.