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Conservative groups aim to sink bipartisan fix to ‘surprise’ medical bills

Conservative groups are gearing up for battle with GOP leaders over bipartisan health care legislation that lawmakers view as one of the few election-year bills that has a shot at making it to President Trump’s desk.

A broad swath of free-market conservative groups is mobilizing to oppose a measure that would ban the so-called “surprise” medical bills patients sometimes receive from hospitals and providers when their services aren’t covered by insurance.

The strategy, in part, is to link the bipartisan proposal to “Medicare for All,” the single-payer health care plan backed by some progressive presidential candidates like Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.).

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“There’s not much legislation out there that will make it to the president’s desk this year and this has a chance,” said Brandon Arnold, president of the National Taxpayer Unions (NTU), which has spent more than $1 million attacking the bill.

Arnold warned that proponents of the measure are “going to run into broad opposition from a wide array of conservative groups who are united on this.”

“We plan to have an impact,” he added.

Patients are subject to surprise bills when they go to a hospital or emergency room that is in-network but treated by an out-of-network doctor.

A bipartisan deal reached last year by the leaders of the House Energy and Commerce and the Senate Health, Education, Labor and Pensions (HELP) committees would essentially ban providers from sending surprise bills and instead require insurers to pay them. The cost would be based on the average price for the services provided, a method called “benchmarking.”

But groups like NTU and Heritage Action argue the legislation is on par with “price controls” or “rate-setting” that would give the government too much power in the private sector and pave the way for Medicare for All, even though Republican backers of the bill proposal fiercely oppose Medicare for All.

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“I’ve heard all the terminology,” said Rep. Greg Walden (Ore.), the top Republican on the Energy and Commerce Committee, in response to the “rate-setting” criticisms.

“It’s not. That’s an easy moniker to throw at it,” he said. “At the end of the day, we didn’t ask for this problem, but we’re going to solve it. We just see it as good policy.”

About a dozen right-leaning groups have come out against the bill, including some of the most well-known fiscally conservative organizations in Washington, like Club for Growth and FreedomWorks. The groups join a high-dollar fight launched last year by hospitals, insurance companies, doctors and private equity groups that are all trying to tilt the measure in their favor. 

After facing angry lawmakers and headlines about patients getting saddled with expensive bills, insurers and providers now agree patients shouldn’t be receiving them. But the two sides have engaged in an all-out war over who should take the biggest hit if changes are made.

Insurers favor the proposal offered by Walden, Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.), Senate HELP Committee Chairman Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.), the ranking member on the HELP panel. The lawmakers had planned to include their bipartisan measure in the 2019 year-end government funding package, but it was left out amid opposition from hospitals and providers and after a rival proposal was offered by the House Ways and Means Committee.

Lawmakers are now pushing to include the legislation in a May spending package, setting the stage for a new round of fights with conservative groups.

Alexander and Walden are retiring at the end of this term, putting extra pressure on them to get the legislation passed.

“I get it. You serve for a long time and think you’re doing what you should for your constituents, and I respect that. But we disagree with this legislation,” said David Williams, president of the Taxpayers Protection Alliance, which opposes the bill. “But it’s not the right thing for the health care industry. I won’t begrudge the effort, but I’ll disagree and make sure it won’t get passed.”

The concerted effort of influential conservative groups has irritated GOP lawmakers who had already been hearing from constituents about separate ads airing in their districts sponsored by private equity groups.

Blackstone Group Inc. and KKR & Co. — two private equity companies that invest in physician staffing firms that often send surprise bills to patients — spent a combined $54 million on ads last year targeting the proposal.

NTU piled on, spending more than $1.2 million since early December on radio and television ads across the country, including in states and districts represented by lawmakers who are working on the legislation.

Last month, NTU spent $38,000 on 165 radio spots that aired in Nashville, Tenn.

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“The only people who don’t want to protect innocent patients from unaffordable surprise medical bills are the people profiting from this anti-competitive flaw in our health care system,” said a GOP official for the Senate HELP Committee.

“Chairman Alexander will continue to keep his bipartisan, bicameral agreement to end the practice of surprise billing at the top of Congress’ to-do list until it is done,” the official said, noting that the measure has President Trump’s backing.

NTU also spent more than $261,000 on ads in the Houston market, which is in part represented by Rep. Kevin Brady (Texas), the top Republican on the Ways and Means Committee.

That spending included $112,000 for an ad that ran Jan. 12 on local TV station KHOU during a Houston Texans playoff game.

In December, Brady and Rep. Richard Neal (D-Mass.), the chairman of the Ways and Means Committee, released a competing approach to ending surprise billing favored by doctors and hospitals. Their measure would still ban providers from sending surprise bills to patients, but it would let a neutral, outside party determine how much the insurer will pay the doctor if an agreement can’t be reached privately.

The legislation is cautiously backed by some of the conservative groups opposing the Pallone-Alexander-Walden-Murray measure, though they are reluctant to offer their full-throated support until the legislative language is introduced.

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“The early outline provided by Ways and Means is a step in the right direction and we look forward to working with them more closely,” said Heritage Action Executive Director Tim Chapman in a statement.

Regarding the other measure, Chapman said, “We view this as a direct step towards Medicare for All and government-controlled healthcare.”

The introduction of the Ways and Means proposal complicates matters since the committee also has jurisdiction over health care.

Pallone and Neal are to meet soon to discuss their plans and find a path forward, Neal said this past week. Walden and Brady’s teams are also talking.

“I actually think we are closer together than people realize,” Walden said. “Our teams are talking. Frank [Pallone] and I remain joined at the shoulder, the hip and probably the ankle too on this matter because consumers are getting ripped off and it’s time to move.”

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