Whoa. Could it be?? Bipartisan, bicameral legislation to end surprise billing & more announced

via email from the House Energy & Commerce Committee:

Bipartisan House and Senate Committee Leaders Announce Agreement on Legislation to Lower Health Care Costs

  • Legislation ends surprise medical bills; funds Community Health Centers for five years; increases the purchasing age of tobacco to 21; lowers prescription drug and other medical costs by requiring more transparency and competition

WASHINGTON, December 8, 2019 — Senate Health Committee Chairman Lamar Alexander (R-Tenn.) and House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-N.J.) along with Ranking Member Greg Walden (R-Ore.) today announced they have reached a bipartisan, bicameral agreement on legislation to lower what Americans pay out of pocket for their health care.

Whether it actually makes it through both the House and Senate and gets signed by Trump or not, just getting this type of announcement itself is pretty unheard of these days for any significant policy.

"I do not think it is possible to write a bill that has broader agreement than this among Senate and House Democrats and Republicans on Americans’ number one financial concern: what they pay out of their own pockets for health care,” Alexander said. "The legislation includes proposals from 80 senators, 46 Democrats and 34 Republicans. It would end surprise billing of patients by creating a new system of dispute resolution that includes arbitration, provide nearly $20 billion for five years of funding for the nation’s 1,400 community health centers, and lower the cost of prescription drugs and other medical services by requiring transparency and competition. Congress should pass the bill promptly and give the American people a very good Christmas present."

I should note that while the Community Health Center funding is a huge relief (I wrote about it potentially expiring a few weeks ago), it's also something which should be renewed on a regular basis anyway, so that's nothing really new.

The increase in the tobacco purchasing age is a good thing, although cigarette use in the U.S. has dropped by 1/3 since 2005 anyway, so I'm not sure how much more of an impact this will have. Of course, "vaping" seems to have replaced cigarettes as the new scourge to deal with, so...

I'll have to read up on the prescription drug competition/transparency items, but my guess is that the single biggest piece of the bill is stopping surprise billing.

It is long past time that Congress protect patients and families from the devastating financial toll of surprise medical bills, and this agreement puts an end to this egregious billing practice,” Pallone said. “It also makes a historic five-year investment in our public health programs, lowers prescription drug prices, improves maternal health outcomes and takes a first step towards addressing the youth tobacco epidemic. This agreement will make health care and prescription drugs more affordable for the American people. I’m hopeful that this bipartisan, bicameral agreement can be voted on quickly so that it can be signed into law before the end of the year.”

“Americans who follow the rules and pay their premiums shouldn’t get stuck with a $50,000 bill because a hospital contracted a NICU to an out-of-network provider, or a $109,000 bill after being rushed to a nearby hospital for a heart attack,” Walden said. “To put it plainly: Americans are sick and tired of being ripped off by surprise medical bills, and they want Congress to act. This announcement brings us one step closer to answering that call for action with bipartisan legislation to prohibit surprise medical bills and take the patient out of the middle. Thank you to my colleagues on both sides of the aisle and Capitol for working so diligently to come to this agreement. Now, we need to continue to work together to quickly send this legislation to President Trump’s desk. It’s time to protect Americans from surprise medical bills, and I am confident that we are going to do just that.”

The Lower Health Care Costs Act of 2019 will reduce what Americans pay out of their own pockets for health care. It would end surprise billing of patients and include a new system for independent dispute resolution often called arbitration. The legislation also increases prescription drug competition and creates price transparency, funds critical public health programs, including Community Health Centers for five years, and increases the purchasing age of tobacco to 21.

The leaders commended Senators Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.) and Representatives Raul Ruiz (D-Ca.) and Larry Bucshon (R-Ind.) for their leadership and dedicated work in developing the solution that ends the harmful practice of surprise medical billing.

Here's my write-up on the earlier version of this bill from over the summer. I don't know how much has changed. Oddly, while Dem. Senator Patty Murray has been a key player in its development, she isn't mentioned at all in the above press release...just Lamar Alexander (GOP Senate), Frank Pallone (Dem House) and Walden (GOP House), along with the others at the end (Cassidy/Hassan in the Senate, Ruiz/Bucshon in the House). I don't know if Murray isn't on board with the final version of the bill or what.

Oddly enough, as of this writing, the only co-sponsors of S.1895 (the Lower Health Care Costs Act of 2019) besides Alexander are Murray and...Joni Ernst? Huh.

There are, however, over a dozen "related bills" from both the House and Seante attached to it, which I assume are baked in as amendments as noted in Alexander's statement above:

  • H.R.965: CREATES Act of 2019 (passed the House already)
  • H.R.2011: Protecting Access to Biosimilars Act of 2019
  • H.R.2296: More Efficient Tools to Realize Information for Consumers Act
  • H.R.4215: Excellence in Maternal Health Act of 2019
  • H.R.4400: Advancing Education on Biosimilars Act of 2019
  • S.192: Community and Public Health Programs Extension Act
  • S.659: Biologic Patent Transparency Act
  • S.1140: Protecting Access to Biosimilars Act of 2019
  • S.1391: Fair Accountability and Innovative Research Drug Pricing Act of 2019
  • S.1618: ECHO 2019 ActR
  • S.1619: Vaccine Awareness Campaign to Champion Immunization Nationally and Enhance Safety Act of 2019
  • S.1636: Ensuring Innovation Act
  • S.1793: Saving Lives Through Better Data Act
  • S.1805: Better Tools for Healthy Living Act
  • S.1897: A bill to establish a process for updating the labeling of certain drugs with outdated labeling.

Stay tuned...

UPDATE: OK, here's some more details via Roll Call, including an answer to my question about Patty Murray's absence from the press release:

The lawmakers have not yet released the text of the agreement.

The three said in a statement that insurance companies and providers would determine payment through a new dispute resolution system that includes arbitration. The statement did not specify how arbitration, which has been the primary flashpoint in the debate, would be used.

“I do not think it is possible to write a bill that has broader agreement than this among Senate and House Democrats and Republicans on Americans’ number one financial concern: what they pay out of their own pockets for health care,” Alexander said. “Congress should pass the bill promptly and give the American people a very good Christmas present.”

Senate HELP Committee ranking member Patty Murray, D-Wash., did not sign on to Sunday’s announcement, but a spokeswoman said she is working with the other lawmakers on a final agreement.

“Senator Murray believes the overall agreement takes important steps forward on a number of issues impacting patients and families, and is working with some members of her caucus on concerns they still have. She didn’t want to sign on to a press release until those were worked through,” said Helen Hare, her communications director.

Meanwhile, the NY Times' Margot Sanger-Katz has some details about how the Surprise Bill portion would actually work:

The proposal would prevent doctors from sending unexpected bills to patients when they are treated in a hospital that accepts their insurance, and would establish a system for resolving related billing disputes between those doctors and insurance companies.

...Passage of the bill is still not guaranteed, but the bipartisan agreement substantially increases the likelihood that the legislation will move this year, most likely as part of a large government funding package expected to pass before a Dec. 20 deadline. The Congressional Budget Office has said that the approach in the deal will save the government money, making it a helpful piece to help offset other priorities.

The deal struck by the two committees shares key features with a bill the Energy and Commerce Committee passed this summer. Doctors who provide care that is out-of-network for a patient’s insurance will automatically be paid the median price of in-network doctors in the area. For certain large claims, doctors will be allowed to appeal to an outside arbitrator for reconsideration. 

A similar process would also apply to hospitals that treat patients in medical emergencies, and to air ambulances (the helicopters and planes that transport patients from remote areas to major hospitals). Private equity is also highly invested in the air ambulance industry.

The solution is similar to one passed in California three years ago. That law appears to have substantially reduced the number of out-of-network bills in relevant medical specialties. But doctors there have said it has lowered their pay.

Well, yeah, I suppose it would...

UPDATE: Something else just occurred to me: Both Lamar Alexander and Greg Walden--the Republican leaders of the respective Senate and House committees--are retiring next year, which might help explain why a piece of useful and decent legislation may actually have a chance of passing Congress for once. It's amazing how freeing it is to no longer have to knuckle under to party leadership...