Dive Brief:
- Fourteen conservative coalitions said Wednesday they are banding together to lobby against government rate setting in negotiating billing disputes between payers and providers.
- The new group, called the Coalition Against Rate-Setting, plans to "fight against government attempts to meddle in the U.S. healthcare system" through messaging, saying rate setting would narrow insurance networks and lead to widespread closures of doctor's offices and hospitals.
- It's a popular chain of reasoning from provider lobbies, which have spent millions to oppose such proposals — including White House-backed, bipartisan legislation from top leadership in the Senate Health, Education, Labor and Pensions Committee and House Committee on Energy & Commerce.
Dive Insight:
So-called surprise bills have been under Capitol Hill's microscope for some time now as patients are saddled with exorbitant, unexpected payments, often for medical care they didn't know was out-of-network with their insurer.
Halting the practice entirely would save $40 billion annually, according to late 2019 research published in Health Affairs. A fix for surprise billing failed to make it into year-end spending legislation, but many think it could be one of the few election-year bills President Donald Trump would be willing to sign. The president has signaled his support for the legislation formed last year in a bipartisan agreement between Senate HELP Chairman Lamar Alexander, R-Tenn., HELP Ranking Member Patty Murray, D-Wash., and House E&C Chairman Frank Pallone, D-N.J., and Ranking Member Greg Walden, R-Ore.
In that proposal, patients are off the hook for any of the unexpected costs. Instead, payers will pay for the out-of-network services based on the average price for the services in that geographic area. The method, called benchmarking, is popular with insurers and loathed by providers because it could sharply decrease their reimbursement.
Now, more than a dozen conservative nonprofits, including the National Taxpayers Union, Americans for Limited Government, Center for Freedom and Prosperity and Heritage Action for America, are forming a cadre to lobby against the bill, called the Lower Health Care Costs Act.
"Americans deserve real solutions from their elected officials, not band-aids on bullet holes that result in scarcity, as government rate-setting always does," FreedomWorks President Adam Brandon said in a Wednesday statement, with Citizens Against Government Waste President Tom Schatz adding rate setting would "move the healthcare system toward Medicare for All" — a common fear for the conservative faction.
But "the benchmark proposals really aren't what I'd consider rate setting," USC-Brookings Schaeffer Initiative for Health Policy Associate Director Loren Adler wrote on Twitter in response to the group. "They're closer to price supports, as the [out-of-network] minimum payment requirement provides upward pressure on in-network rates but is in no way a ceiling" because it doesn't constrain market negotiation between doctor and hospital.
What started out as an effort to protect patients from insane surprise bills has turned into an economic battle over how much out-of-network providers should get paid and an ideological fight over whether setting a payment benchmark is a prelude to price controls. https://t.co/nFttzvDJVS
— Larry Levitt (@larry_levitt) January 22, 2020
Despite the hullabaloo, lawmakers are fighting to get the legislation included in a May spending package, according to The Hill reporting. But in December, House Committee on Ways and Means leadership released a competing proposal that would still hold patients blameless but would send the bill to outside arbitration to determine how much the payer reimburses the provider.
Doctors and hospitals support that method, but specific details of the plan, helmed by Reps. Richard Neal, D-Mass., and Kevin Brady, R-Texas, are vague, and its introduction could muddy the way forward for the House E&C and Senate HELP's solution.