Analysis: House Ways & Means Health Subcommittee advances its surprise-bill draft legislation

• The House Energy and Commerce Health Subcommittee last week approved its surprise bill legislation that would protect patients against high out-of-network rates in certain circumstances.
• Debate around raising the federal debt ceiling is a possible hang-up that could delay passage of the bill.
• With the House scheduled to depart for its traditional August recess on July 26 and the Senate to do so on August 3, there is little time left to resolve the issue before the break, which also could delay action on surprise bill legislation.

A July 11 Congressional Quarterly article reported, “The House Energy and Commerce Health Subcommittee approved its Surprise Bill legislation that would protect patients against high out-of-network rates in emergencies and other times when they expect their insurance to cover hospital services on Thursday.”

The full Energy and Commerce Committee was expected to take up the bill this week.

CQ went on to report, “Before then, lawmakers will try to work out differences with members who object to how the surprise billing measure would establish payments for hospitals and health care providers.

The bill would prohibit patient cost-sharing beyond the typical insured amount in cases when patients go to an emergency room where their coverage isn’t accepted, or when they have a procedure at a hospital that’s within their insurance network but one of the doctors involved doesn’t accept that insurance. In those cases, the insurer would pay the medical provider the median in-network rate for the geographic area.

But many panel members from both parties worry that this kind of rate-setting will result in doctors trying to make up for lost funds by consolidating with larger hospitals, narrowing their insurance networks or going out of business.”

To address this issue, the CQ article says, “A bipartisan group is pushing committee leaders to add language from a proposal (HR 3502) that would let an independent entity settle disputes over payments between insurers and providers before next week’s markup.”

However, this provision doesn’t have universal support.

Takeaway

There is opposition in some quarters of Congress to adding an arbitration option for cases where providers aren’t satisfied with the calculated geographic median payment for the service. However, I still don’t anticipate this will be a stumbling block to passing a bill and anticipate some form of arbitration will be added late in the legislative game.

However, there’s still a possible hang-up that could delay passage of the bill. While it’s not directly related to surprise bills, you should pay attention to the debate around raising the federal debt ceiling.

While the CBO is still projecting the federal government will be able to meet all of its obligations without additional borrowing (requiring an increase in the debt ceiling) until early October, the Bipartisan Policy Center believes the “X date” could move up to early September based on softer projections of tax revenue.

What happens when we hit the X date? The U.S. Treasury won’t have enough cash on hand to meet the government’s financial obligations and will then have to prioritize which bills to pay potentially jeopardizing the U.S. government’s credit rating.

With the House scheduled to depart for its traditional August recess on July 26 and the Senate on August 3, there are not a lot of shopping days left to resolve the issue before the break, which could delay action on surprise bill legislation.

And if prior to the break Congress can’t come up with a resolution that increases the debt ceiling or suspends it beyond the end of the year, this issue could suck up much of the legislative oxygen on the Hill when they get back from break. As a result, other bills that otherwise have a decent shot at passage will be pushed to the side until the debt ceiling is addressed.