Dueling Legislation to Address Surprise Medical Billing Clears Key House Committees

February 13, 2020

Activity on legislation to address surprise medical bills heated up this week in Washington, D.C., with both the House Education and Labor and the House Ways and Means Committees passing separate legislation to address surprise medical bills.

The House Education and Labor Committee on Feb. 11 passed H.R. 5800, the Ban Surprise Billing Act. This legislation is very similar to bills previously passed by the Senate Health, Education, Labor and Pensions and House Energy and Commerce Committees that WHA cautioned lawmakers against in December 2019. It would resolve instances of surprise billing by requiring hospitals to be paid a benchmark rate for surprise medical bills below $750 while allowing both sides to go to arbitration for bills above that threshold. WHA has opposed this approach because it would create a ceiling for price negotiations, giving insurers undue leverage and potentially forcing some providers out of network. Eventually, the benchmark rates would function as a fee schedule of sorts in the commercial market.

WHA sent out targeted HEAT alerts to constituents of Wisconsin Congressman Glenn Grothman, asking them to urge Rep. Grothman to vote against this legislation in committee. Notably, Rep. Grothman joined 12 of his colleagues from both sides of the aisle in voting against this legislation, which was approved by a vote of 32-13. He and his colleagues noted concerns from WHA and others that a government-imposed benchmark would be very detrimental to the overall health care system. Instead, they cited legislation introduced by the House Ways and Means Committee as their preferred approach.

On Feb. 12, the House Ways and Means Committee passed its solution to surprise medical billing on a unanimous, bipartisan vote. H.R. 5826, the Consumer Protections Against Surprise Medical Bills Act of 2020, uses independent dispute resolution as the means of resolving disagreements between providers and health insurers. WHA again activated its HEAT network in advance of the vote, and also sent Reps. Ron Kind and Gwen Moore, who both serve on the Ways and Means Committee, a letter of support noting how this legislation would protect patients while also supporting Wisconsin’s nation-leading health care environment. The legislation would create a 30-day period where providers and insurers would be encouraged to resolve surprise billing disputes. If an agreement could not be reached by then, both sides would present their case to an independent mediator who would decide in favor of one or the other.

Because the Ways and Means legislation is so different from legislation passed in other committees, it is unclear how Congress will work to forge agreement on this issue. President Donald Trump tweeted a note of encouragement shortly after the Ways and Means legislation passed, asking Congress to work out the differences and send him a bipartisan bill he could sign. With a number of health care provisions expiring on May 22, Congress could decide to wrap surprise billing legislation into a package to extend these expiring health care provisions. WHA will continue to advocate strongly for legislation that preserves free-market negotiations in Wisconsin.

For more information, contact WHA’s Director of Federal and State Relations, Jon Hoelter.

This story originally appeared in the February 13, 2020 edition of WHA Newsletter