The House held hearings this week on issues related to surprise billing and budget considerations for implementing a single-payer healthcare system. Along with prescription drugs, these two issues continue to dominate the healthcare conversation on Capitol Hill in recent weeks. However, the conversation on single-payer is likely to end at the committee level, as Democratic Party leaders avoid confronting the divide within their caucus on the issue. But leadership in both parties have demonstrated a strong preference for advancing surprise billing legislation within the coming months, and ideally before the August recess that is set to begin in just nine weeks.
On Tuesday, the House Ways and Means Health Subcommittee held a hearing on surprise medical bills, and NAHU submitted written testimony for the hearing. The hearing included testimony from doctors, insurers, hospitals and large employers on how to prevent patients from receiving unexpected and high-cost medical bills. It focused on issues regarding in-network versus out-of-network rates, bundling and rate setting, transparency, impact on rural areas, and Medicare reimbursement. Witnesses also provided feedback on the approaches taken by New York, California, Pennsylvania, Oregon, and Nevada, the “greatest of three policy,” and private negotiation and arbitration. Overall, witnesses and lawmakers agreed that regardless of the ultimate solution, patients should be removed from the process of balance billing.
Committee chairman Lloyd Doggett (D-TX) specifically used the hearing to promote H.R. 861, legislation he’s sponsored to require detailed out-of-network cost notices for any hospital seeking to participate in Medicare to provide to any out-of-network insured patients, whether the patients were covered by Medicare or by other health insurance programs. Patients would have to be notified on the likelihood that they would be getting care out of network, and explaining what kinds of bills they might end up having to pay. Hospitals failing to provide the notice would only be able to bill an insured patient only for the cost-sharing amount the patient would have owed if the care had been provided by an in-network provider.
On Wednesday, the House Budget Committee held a hearing to discuss the key design components of a single-payer healthcare system. NAHU submitted written testimony for this hearing as well. The hearing included testimony from several staffers of the nonpartisan Congressional Budget Office, who referred to the report issued earlier this month on key considerations for establishing a single-payer system. The CBO staffers stressed that shifting the American healthcare system to single-payer would “require significant additional government resources” and come with major trade-offs, although it is too early to determine whether such a plan would ultimately increase or decrease overall health spending, due to ambiguities as to who would be eligible and what benefits would be covered.
While the hearing was intended to focus exclusively on budget considerations, unsurprisingly, members of the committee used the time to express their thoughts on enacting such a plan. Democrats generally expressed support of the CBO’s report as a “road map” for pursuing government-run healthcare, while Republicans called the costs “monstrous,” that implementing such system would lead to fraud, doctor shortages and expanded wait times, and that the report was “especially helpful in showing that these ideas will never work in America.”
Among the witnesses, the CBO staffers agreed that more people would have health insurance under a single-payer system and that it could potentially lead to an increase in incomes if employers increase wages in the absence of providing health benefits. They did acknowledge potential challenges with more lag time for patients to receive treatments and lower reimbursement rates for providers, and especially rural hospitals.
The hearing is the second on single-payer healthcare after the House Rules Committee held a first-ever hearing on Medicare for All earlier this month. That hearing was generally non-controversial as Democrats preferred to use the time to make general statements on the benefits of universal coverage, rather than debate the nuances of competing proposals for achieving that goal. However, in this hearing several Democrats used the opportunity to offer their own alternatives to Medicare for All that wouldn’t force everyone into a government-run system.
The House Ways and Means committee has indicated that it will hold its own hearing on the topic, but has not made any schedule commitments yet. House Speaker Nancy Pelosi earlier this year pledged that the House would hold two hearings on Medicare for All, although advocates are unlikely to be satisfied unless there is further consideration of the legislation. The sponsor of the House Medicare-for-All bill, Representative Pramila Jayapal (D-WA), has said she expects the budget committee to hold a hearing specific to her bill, rather than the general hearing on single-payer from this week.