The House held hearings on Wednesday on discussion draft legislation to address surprise billing and policy options for achieving universal coverage, to include Medicare for All. The hearings provided an opening for members of both parties to offer their competing visions for these policies. For surprise billing, this demonstrated that while there is near universal agreement that patients should be removed from surprise billing disputes, there is not consensus on the use of arbitration. For achieving universal coverage, the hearings continue to demonstrate the significant disagreements within the Democratic caucus on the role of Medicare for All, Medicare and Medicaid buy-ins, and similar policy proposals. As these issues remain among the top healthcare issues of this session of Congress, NAHU will continue to work closely with policymakers and their staff to advance our priorities.
The House Energy and Commerce Health Subcommittee’s hearing on surprise billing was to review their bipartisan discussion draft legislation, to which NAHU submitted feedback last month. Leadership in both parties have demonstrated a strong preference for advancing surprise billing legislation within the coming months, and ideally before the August recess. However, the hearing did not result in any clear consensus among policymakers on the path forward, with committee members divided on the issue of arbitration, a core component of several proposals to address surprise billing, but not for the discussion draft legislation offered by the committee’s Democratic and Republican leaders.
Notably, the disagreements over arbitration were not split along party lines. Representative Raul Ruiz (D-CA), a physician prior to his election to Congress in 2012, used the hearing to advance his own arbitration system that would give providers more negotiating power with insurers and would establish an arbitration system similar to those in New York and Texas. That idea is supported by physician groups as well as Representative Larry Bucshon (R-IN), a former cardiothoracic surgeon and fellow committee member. They claim that arbitration would not have an effect on inflation of overall rates.
Committee Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR) introduced the discussion draft legislation and used the hearing to advance the potential of transparency and benchmark pricing. Pallone claimed that “This debate has shed light on the fact that some providers' charges and hospital fees are inexplicably high, and I worry that if Congress chooses the wrong approach, consumers will simply end up paying those costs through higher premiums.” NAHU supports much of the language in the proposal offered by Pallone and Walden to avoid arbitration by instead focusing on benchmark pricing, and formed an industry stakeholder coalition this week in support of such an approach.
The House Ways and Means Committee hearing on pathways to universal coverage was the third overall hearing on single-payer healthcare this session and the first for a committee of jurisdiction. It follows a hearing last month in the House Budget Committee that largely dealt with budget considerations of single-payer systems globally, and a House Rules Committee hearing that was mostly non-controversial as Democrats offered various ideas on how to achieve their common goal of universal coverage. Witnesses at this week’s hearing included former CMS Administrator Donald Berwick, former deputy CMS administrator Chiquita Brooks-LaSure, Washington State Health Benefit Exchange CEO Pam MacEwan, Kaiser Family Foundation Medicare Policy director Tricia Neuman, Galen Institute President Grace-Marie Turner and patient advocate Rebecca Wood.
The hearing focused on examining overall considerations for establishing a universal healthcare system in the U.S., with Medicare for All among the policies discussed among a menu of options. Committee members asked about the bill sponsored by Representative Pramila Jayapal (D-WA), along with a public option, a Medicare buy-in, and other similar proposals to expand coverage. The hearing also took a more global look at tradeoffs of the government taking a larger role in the insurance market, how to pay for a single-payer healthcare system, what benefits it would cover, wait times, and challenges and benefits of moving to a government-run health plan. They also discussed the role of employer-sponsored health insurance, the recent expansion of short-term plans, the ACA’s cost sharing reduction (CSR) subsidies, Medicare prescription drug negotiation and surprise medical billing.
Committee Chairman Richard Neal (D-MA) opened the hearing by voicing his concerns on Medicare-for-All while offering a strong defense of the ACA—showing once again the divisions within the party on how to best move forward on health reform. There was some agreement between Grace-Marie Turner and Pam MacEwan on the patient choice limitations of a government-run system that could also lead to more expensive care, longer wait times, lower quality of care, provider shortages, and rationing. Donald Berwick recommended a multi- pronged approach to achieve universal coverage that covers every single American regardless of income, and to utilize Medicare to more directly lower the cost of prescription drugs. Panelists also generally found agreement in the need for federal funding of the CSR program and reinsurance.
Once again, the hearing provided a largely non-confrontational way for Democrats to advance their own ideas on achieving universal coverage without exposing the party’s divide on how to achieve it. Democratic Party leaders are continuing to walk a fine line of satisfying single-payer advocates in their caucus without actually advancing legislation that would expose the significant rift within the party. Representative Jayapal has continued to ask for a hearing specific to her bill in a committee of jurisdiction, which, while there have now been three hearings on the topic, none have gotten into policy specifics of particular legislation or her specific Medicare-for-All bill.