Congress likely to punt on drug prices, surprise billing as year-end deadline nears

by Robert King | Dec 16, 2019

Major healthcare priorities on drug pricing and ending surprise medical billing appear likely to be punted into 2020.

While the House passed a major bill Thursday to give Medicare the power to lower drug prices, the legislation appears highly likely to die in the Senate. A bipartisan House-Senate deal on legislation to tackle surprise medical bills has also run aground after release of a competing proposal in the House.

The lack of progress comes as Congress attempts to make a flurry of decisions on legislation before the end of the year, as 2020 is a presidential election year in which it’s unlikely much gets done.

Curveball in the fight to end surprise bills

Entering this year, legislation to end surprise medical bills had large bipartisan support and appeared likely to make it through Congress.

But providers have launched major ad campaigns and lobbying efforts to stall momentum over a dispute on how they should be paid for out-of-network charges. Providers want to use an arbitration method where an independent party decides an out-of-network charge and payers want a benchmark rate for such charges.

Earlier this week, a deal was reached between the House Energy and Commerce Committee and the Senate Committee on Health, Education, Labor and Pensions. The legislation would use a benchmark rate but include an arbitration backstop for bills totaling more than $750.


Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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