Conservative lawmakers warn Pelosi about ‘rate-setting’ surprise billing fix

Conservative Republicans came out against a bipartisan proposal that would end the “surprise” medical bills patients sometimes get from doctors and providers. 

In a letter to House Speaker Nancy Pelosi (D-Calif.) dated Monday, 39 Republicans, led by Rep. Andy Harris (R-Md.) warned against passing a bill that would impose what they see as “government-dictated price controls” on private negotiations between insurers and providers. 

“Surprise medical billing proposals that give the federal government the power to set rates between two private entities — insurers and health care providers — could have a devastating impact on our constituents,” reads the letter, which was signed by some of the most conservative Republicans in Congress, including Reps. Mark Meadows (R-N.C.) and Jim Jordan (R-Ohio.) 

Congress wants to end the practice of surprise billing, which can happen to patients who go to an in-network hospital or emergency room but are treated by an out-of-network doctor. When insurers don’t pay the full amount, providers often bill patients for the remainder. 

While lawmakers agree insurers should pay these bills, a debate is brewing over how much they should have to pay providers for their services. 

One measure offered by Reps. Frank Pallone (D-N.J.) and Greg Walden (R-Ore.) that is favored by insurers would set provider rates based on the average price for the services provided in a geographical area, a method called “benchmarking.”

But conservatives argue that method would reduce access to care and increase the power of the federal government. 

“To be clear, we believe that patients should be protected from surprise medical bills, which can place a heavy financial burden on individuals that received care outside of their insurance network,” the letter states. 

“In pursuing such protections, there exist several proposals that hold patients harmless, increase transparency and resolve disputes that arise from surprise bills,” it adds. 

The lawmakers didn’t endorse an alternative proposal. But a rival bipartisan measure offered by members of the House Ways and Means Committee gives the decision on how much the insurers should pay the providers to an outside arbiter. That approach is favored by hospitals.

Pelosi is hoping to include a surprise billing fix in a spending package Congress must pass by May 22.