As Congress returns to Washington, efforts to limit surprise billing seem to be at a stalemate, though backers say they aren't giving up.
Intense lobbying by industry has taken its toll on the potential for a fix, once viewed as a promising field of action with bipartisan backing and even mention from President Donald Trump.
"There's been a lot of pushback from industries, particularly the providers, about the details of surprise billing legislation and it seems, frankly [unclear], whether legislation should move forward at all," said Claire McAndrew, director of campaigns and partnerships for Families USA.
"Members of Congress will have to stay strong against the slowdown and that pressure," she said.
Headlines over surprise billing hardly died down over the summer recess. Reports of patients stuck with unexpected and enormous bills from out-of-network providers continue to rankle voters and lawmakers alike.
Payer and provider groups have dug in. Payers largely are pushing for rate setting and providers for arbitration.
Industry groups have lobbied strongly against surprise billing bans, throwing money at the issue to persuade lawmakers as well as rolling out public-facing campaigns that target certain policies. Just this week, the group Physicians for Fair Coverage launched a new ad blitz, arguing proposals that "would put insurance companies in charge" could lead to a shortage of emergency physicians and threaten care quality.
The Senate Health, Education, Labor and Pensions Committee marked up and easily passed out of committee a package that included the surprise billing ban in June, but no floor vote is scheduled. A spokesperson for committee chairman Sen. Lamar Alexander, R-Tenn., told Healthcare Dive staffers were preparing for a vote of the full Senate before the next recess.
In the House, several committees are working on legislation, including the House Energy and Commerce Committee, which also passed its version in July. A provider-backed amendment adding an arbitration clause was included at the last minute.
A congressional aide told Healthcare Dive surprise billing is still a major priority for Energy and Commerce, which is waiting to see what draft makes it through other committees in hopes of a full vote before the end of the fiscal year.
Lobbying efforts from private equity-backed physician staffing firms have been targeting lawmakers, but "we think that we have the right solution," the aide said.
James Gelfand, senior vice president for health policy at the ERISA Industry Committee told Healthcare Dive the flood of lobbying dollars against surprise billing legislation could be doing more harm than good for industry groups opposed to a ban.
"I think that the money has intimidated some people but it's pissed off just as many members of Congress," he said. "There are some who are very worried about negative advertising but there are more saying how dare they run these ads attacking us when we're trying to solve this and there's bipartisan agreement that there's a real problem."
Gelfand said he believes legislation is still likely to pass in some form, and scales are tipping away from arbitration. "From everything we're seeing and the meetings that we're having and the conversations, it still seems like this is coming," he said.
Drug pricing also on the table
Bills aimed at lowering prescription drug prices and pushing for more transparency also gained some traction before the recess, and the Democratic leadership in the House is expected to release its plan addressing the issue soon.
Prior efforts this year from the Trump administration, however, have stalled or faltered. A plan to force drug manufacturers to publish prices in direct-to-consumer advertisements has been halted in court. Meanwhile, the administration pulled back its plan to end drugmaker rebates to pharmacy benefit managers in Medicare and Medicaid in July.
Earlier this year the Senate Finance Committee marked up its drug pricing package, which includes more than 30 separate provisions the Congressional Budget Office estimates could save about $100 billion over the next decade. It would require drugmakers to pay back Medicare if their relevant prices rise above the inflationary rate, cap patient costs in Medicare Part D and push more information discloser from manufacturers, among other changes.
It does not, however, give Medicare the power to negotiate prices with drugmakers, a proposal that is reportedly in the Democrats' plan. Analysts said they expect a vote on the Senate plan later this month or in early October.
Healthcare was a turning point for many races in the 2018 election, and polling continues to show strong interest from voters. More than 80% of Democrats said it was "very important" for candidates to talk about healthcare, topping a list of topics including immigration and gun policy, according to the latest tracking poll form the Kaiser Family Foundation.
If the session passes without a surprise billing ban or a concrete plan to bring down drug prices, voters won't be pleased. Patient advocates have been optimistic with progress earlier this year, so if industry efforts to derail regulation succeed, it will be viewed as a major missed opportunity, McAndrew said.
"These are real kitchen table, pocketbook issues that the American people are begging Congress to take action on," she said.