Framing the Week

Lawmakers break for a one-week recess after a busy work period, making incremental progress on the surprise medical billing front and beginning the annual appropriations process. Senate Majority Leader Mitch McConnell (R-KY) and House Budget Committee Chair John Yarmuth (D-KY) have already said that they will stick to the topline fiscal 2021 spending levels agreed to in the Bipartisan Budget Act of 2019 (H.R. 3877) rather than pursue a budget resolution – likely denying the President the opportunity to attempt entitlement or tax reform through the budget reconciliation process.

Surprise Medical Billing

While last week’s back-to-back markups of surprise medical billing legislation were significant steps in reaching a compromise, they highlighted several gaps in consensus – with the biggest one being the mechanism to resolve payment disputes. Of note, a White House official raised concern that overusing arbitration could lead to higher health care costs – providing a boost to the dual solution of benchmark payments and limited arbitration pushed by the Senate Health, Education, Labor and Pensions (HELP) Committee, House Energy and Commerce (E&C) Committee, and House Education and Labor (Ed & Labor) Committee over the House Ways and Means (W&M) Committee’s arbitration-focused approach. In terms of government savings, the Ed & Labor and HELP and E&C proposals appear to be the frontrunners, as they are estimated to save about $24 billion over 10 years, according to the Congressional Budget Office, compared to $17.8 billion for the W&M approach. Still, the President is calling on all four Committees to work together to come up with a bipartisan, bicameral fix.

As the issue of surprise medical billing is complex and requires a nuanced solution, lawmakers will also have to come together on several key issues, such as whether arbitration can be used to resolve payment disputes for multiple services; what should and should not be considered by the arbiter in making a determination (e.g., usual and customary charges, billed charges); how many hours in advance is consent required in order to balance bill for certain services (48 hours or 72 hours); and whether consumer protections should be extended to ambulance services.

Drug Pricing

On prescription drug pricing, Senate Finance Committee Chairman Grassley (R-IA) is employing his three-pronged approach of “negotiating with House speaker Nancy Pelosi, gaining more Republican senate support, and getting endorsements from the President.” Notably, during a Senate Finance Committee hearing on the President’s FY 2021 budget, HHS Secretary Azar stated he “fundamentally disagrees with the notion the inflation penalty provisions that are in the Grassley-Wyden bill constitute price caps or price controls.” Chairman Grassley is aiming to earn the support of at least 25 more Senate Republicans in order to convince Majority Leader McConnell to bring S. 2543 up for a floor vote.


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Alyssa Llamas has a diverse background in health policy and public health, with seven years of experience in government, research