Conservatives Clash on Surprise Medical Bills

POMPANO BEACH, FL - APRIL 20: Emlyn Louis, MD speaks with Julia Herrera as he examines her
Joe Raedle/Getty Images
Sean Moran

Conservatives on and off of Capitol Hill continue to clash over how to address surprise medical bills, a prominent issue in healthcare reform.

Last week, conservative groups such as the Heritage Foundation and FreedomWorks as well as Sen. Rand Paul (R-KY) came out against the Senate’s leading legislation to address surprise medical bills, contending that it would lend to too much government interference in the healthcare industry.

Surprise medicals bills occur when a patient sees a doctor out of his health insurance network and that doctor bills the patient for the charges that the insurer will not pay.

Congress’s leading solution, the Lower Health Care Costs Act, was proposed by Senate Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) and ranking member Patt Murray (D-WA). The bill would ban doctors from charging patients more than an in-network provider would and also would require health insurers to pay out-of-network providers the median in-network rate for the service for the geographic area.

The Senate HELP Committee passed the bill out of committee last week.

The legislation has garnered opposition from conservative lawmakers and organizations off of Capitol Hill.

“If you fix the price that ER doctors work at, you will get a shortage … This is what happened to Chavez, it’s what happened to Maduro. I don’t think we’re becoming Venezuela soon, but this is part of what they do down there,” Sen. Paul said of the legislation’s potential effects last week.

Heritage Foundation scholar Doug Badger said last week, “If government rate setting is viewed as a ‘patient protection’ in these circumstances, it will lead to efforts to ‘protect’ patients through government rate setting in others.”

Conservative lawyer Paul Clement wrote that the approach could violate the Constitution.

FreedomWorks announced a $50,000 ad campaign against what it referred to as the “hidden Republican efforts to bring us ever closer to socialist-style ‘Medicare for All’ proposals.'”

The Manhattan Institute, another conservative think tank, led a coalition letter with more than two dozen conservative organizations saying that the providers’ preferred approach could establish “an inflationary dynamic that accommodates and encourages the rapid growth of costs.”

Much of the resistance against the legislation arises from the method by which payers and providers resolve disputes.

Sen. Alexander’s method, benchmarking, made it into the final form of the legislation. Benchmarking stipulates that insurers would pay providers the median in-network rate, meaning that the rate would remain similar to what the plan pays other doctors in the area for the same procedure. Badger contends that benchmarking would amount to “rate setting” because they believe that it would set arbitrary price controls on the cost of healthcare services.

However, Alexander said in a June 19 press release that the Congressional Budget Office (CBO) contended that benchmarking would cut healthcare costs the most compared to other methods.

Sen. Bill Cassidy (R-LA) preferred the so-called baseball-style arbitration system, which would have the health insurer and the doctor, if they could not reach an agreement on reimbursement, present their preferred solutions to an independent arbiter. The arbitrator could then resolve the dispute between the healthcare provider and the health insurer.

One study from the Georgetown University Health Policy Institute reviewed the implementation of a similar law to address surprise medical billing and found that state officials have seen a “dramatic” decline in consumer complaints since the law went into effect.

House Energy and Commerce Committee ranking member Greg Walden (R-OR) did not respond to a request for comment from Breitbart News regarding conservative criticism that the legislation would amount to “rate setting” of healthcare prices.

Chairman Alexander was not able to respond to a request for comment from Breitbart News.

Sen. Cassidy’s Stop Medical Bills Act, which had baseball-style arbitration, received enormous bipartisan support; over one-fifth of the Senate cosponsored his legislation.

Despite many of the conservative groups’ opposition to the bill, it did receive praise from various healthcare experts and groups.

Sens. Bill Cassidy, Maggie Hassan (D-NH), and Lisa Murkowski (R-AK) voted for Alexander’s choice, even though they pushed for the baseball-style arbitration proposal. The Louisiana Republican said that he continues to have reservations about benchmarking.

“This is entirely for the insurance companies,” Cassidy said of benchmarking last week. “I’m surprised that my colleagues on the other side of the aisle running for president are OK with this.”

However, despite Cassidy’s reservations about the bill in its current form, Chairman Alexander said that the legislation could still include independent arbitration before it gets to the Senate floor for a vote.

“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 said last week.

At a mark up last week, the committee moved towards Sen. Cassidy’s preferred prescription for surprise medical bills by passing an amendment that would require insurance companies to post accurate lists for in-network providers so that patients have a better chance of avoiding surprise medical 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.”

Sean Moran is a congressional reporter for Breitbart News. Follow him on Twitter @SeanMoran3.

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