dark skies over Washington D.C. and capitol building

It has bipartisan support. Even the White House is behind it. But although they're agreed that they have to do something, a Senate bill designed to tackle the problem of surprise medical bills is spurring some hefty disagreements—among Republicans.

The Wall Street Journal reports that getting a plan through Congress this month could be problematic, given the “furious lobbying” and “disagreements among Republican lawmakers” that are currently threatening the path of the legislation.

A bill from senators Lamar Alexander, R-TN, and Patty Murray, D-WA, was approved by Alexander's Senate Health Committee in June. The next step is a vote by the full Senate, but there's a battle brewing over who's going to take the financial hit currently going to patients: doctors or hospitals. There's also disagreement over how to resolve disputes, as well as some legal issues.

There are plenty of other provisions in the bill, which has a counterpart in the House from the Energy and Commerce Committee heads. And it has bipartisan support—all but on those finer issues involved with surprise medical bills.

Alexander supports protection for patients via benchmarking, “by having the insurers pay the out-of-network doctors a median in-network rate, an amount based on what other doctors in the same geographical area get paid,” according to the report, and insurers and employers who provide coverage like that idea.

Not so hospitals and doctor groups, who want arbitration to settle the question of who charges how much to whom. And in a letter sent by the American Hospital Association, a trade group for the industry, to Alexander in June, the group said, “We are concerned that the rate-setting provision of the legislation is a plan-determined, nontransparent process that will upend private payment negotiation.”

Another dissenting voice is that of Paul Clement, a former GOP solicitor general, who at the behest of the doctors' group Physicians for Fair Coverage penned a brief that termed the benchmark solution unconstitutional, saying that it violates the Fifth Amendment clause limiting the power of eminent domain.

“What if you said workers can't strike?” Clement saying in an interview, adding “the government would essentially be regulating doctors like utilities.” In that scenario, according to WSJ, “doctors must treat everyone in an emergency” and therefore would have to just accept the rates on offer with no choice in the matter.

And some who were in favor of the bill could be persuaded otherwise if the fight escalates—such as senators Ted Cruz, R-TX, and Mike Lee, R-UT. They're already on the fence.

The bill is likely to make it to a floor vote, since it contains a provision on upping the age on tobacco products in a quest to slow vaping. That provision is supported by no less a personage than Mitch McConnell, R-KY, as well as Tim Kaine, D-VA. McConnell's involvement practically guarantees a vote, although it doesn't guarantee passage—Democrats are looking for pressure points on Republicans concerning other tough issues, such as taking a stand on the current lawsuits against the Affordable Care Act. And that kind of a fight, which could leave Republicans in a bad light, is something McConnell is definitely not anxious for.

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Surprise disagreements hamper surprise medical bill legislation

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