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GOP Disagreements Could Make It Harder to Tackle Surprise Medical Bills

Michael Rainey
Lawmakers had hoped they could agree on a plan this summer that would curb surprise medical bills, but intense lobbying by interested groups and disagreements among Republicans are making it difficult to move forward, The Wall Street Journal’s Stephanie Armour and Kristina Peterson report.While there is broad agreement that patients need protection from large and unexpected charges that sometimes appear on hospital bills, especially as a result of emergency care, differences have emerged over how to settle billing disputes and who should be forced to absorb any financial hits.A bill from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) would allow insurers to pay out-of-network doctors, who are often the source of unexpected charges, at a benchmark rate determined by the cost of other doctors in the same area. But this approach, which is supported by insurers and employers, is opposed by some hospital and doctor groups, who are calling for an arbitration system to settle disputes.On top of that, some conservative Republicans, including Sens. Mike Lee (R-UT) and Ted Cruz (R-TX), have expressed concerns that the benchmark approach amounts to rate-setting by the government, which would violate their allegiance to free markets and could raise constitutional issues.  Together, these complications suggest the bill has a difficult road ahead of it. Senate Majority Leader Mitch McConnell (R-KY) has signaled that he supports the Alexander-Murray bill, but there’s no guarantee it will pass if he does bring it to the floor, especially if Democrats use the opportunity to take a stand on a variety of health care-related issues, including the status of the Affordable Care Act,  Armour and Kristina Peterson said.Like what you're reading? Sign up for our free newsletter.

Lawmakers had hoped they could agree on a plan this summer that would curb surprise medical bills, but intense lobbying by interested groups and disagreements among Republicans are making it difficult to move forward, The Wall Street Journal’s Stephanie Armour and Kristina Peterson report.

While there is broad agreement that patients need protection from large and unexpected charges that sometimes appear on hospital bills, especially as a result of emergency care, differences have emerged over how to settle billing disputes and who should be forced to absorb any financial hits.

A bill from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) would allow insurers to pay out-of-network doctors, who are often the source of unexpected charges, at a benchmark rate determined by the cost of other doctors in the same area. But this approach, which is supported by insurers and employers, is opposed by some hospital and doctor groups, who are calling for an arbitration system to settle disputes.

On top of that, some conservative Republicans, including Sens. Mike Lee (R-UT) and Ted Cruz (R-TX), have expressed concerns that the benchmark approach amounts to rate-setting by the government, which would violate their allegiance to free markets and could raise constitutional issues.  

Together, these complications suggest the bill has a difficult road ahead of it. Senate Majority Leader Mitch McConnell (R-KY) has signaled that he supports the Alexander-Murray bill, but there’s no guarantee it will pass if he does bring it to the floor, especially if Democrats use the opportunity to take a stand on a variety of health care-related issues, including the status of the Affordable Care Act,  Armour and Kristina Peterson said.

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