On February 7, 2020, two House committees released competing proposed bills designed to shield patients from “surprise” medical bills. These bills, like others that were proposed last year, would protect patients from liability for fees charged by out-of-network physicians when patients receive care at in-network emergency departments. The proposal from the House Ways and Means Committee includes a provision to establish an independent mediated negotiation process for reimbursement disputes between providers and insurers, instead of allowing insurers to decide the reimbursement amounts in the first instance. The competing proposal from the House Education and Labor Committee, by contrast, resembles prior proposals that allow insurers to decide reimbursement for out-of-network providers in the first instance. The House will need to reconcile all versions of any bills that pass committee before any vote is taken.

The main disputes regarding the different versions of the surprise medical billing legislation concern the amounts insurers will have to pay out-of-network physicians when the patient is taken out of the process and the mechanisms available to providers for disputing reimbursement amounts. Leaders of the House Energy and Commerce Committee, in coordination with the Senate Health, Education, Labor, and Pensions Committee, reached an agreement on a compromise proposal in December 2019 to set the payment to physicians at the median in-network negotiated rate in the geographic area, with an option of pursuing arbitration for bills in excess of $750. That bill has the support of the White House. Doctors and hospitals have lobbied against the House Energy and Commerce bill on the grounds that they believe it would lead to damaging cuts on provider reimbursement. The House Education and Labor Committee released a bill on Friday, sponsored by Chairman Robert Scott (D. Va.) and Ranking Republican member Virginia Foxx (R. N.C.), that closely resembles that from the Energy and Commerce Committee, and a vote on that bill is planned for markup on Tuesday, February 11.

The House Ways and Means Committee bill, by contrast, gives the decision on how much the insurer should reimburse physicians to an outside arbiter in the first instance, rather than the insurer, although that arbiter will have to consider the median rate usually paid for that service in making its decision. This bipartisan legislation is sponsored by the Chairman Richard Neal (D. Mass.) and Ranking Republican member Kevin Brady (Texas). Reps. Neal and Brady released a joint statement on Friday defending their bill as “a more balanced negotiation process.” The House Ways and Means Committee is planning to vote on the legislation on Wednesday, February 12. Rep. Donna Shalala (D. Fla.), a former secretary of Health and Human Services and member of the Education and Labor Committee, said on Friday that she supports the Ways and Means approach and criticized the bills from Energy and Commerce and Education and Labor as giving insurance companies too much power.

Both parties are incentivized to finalize a deal by May 22, 2020—the deadline for Congress to pass a bill funding government healthcare programs. The differences between the bills that pass out of committee would have to be resolved for any bill to move forward.

The text of the House Ways and Means Committee bill is here, and the press release from Ways and Means can be found here. The Education and Labor bill is here, and the press release on that bill can be found here.