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Congress reaches agreement to raise tobacco purchase age to 21

WASHINGTON >> Key House and Senate committee leaders announced a bipartisan agreement today on draft legislation to prohibit surprise medical bills and raise the legal age to purchase tobacco to 21.

The agreement raises the odds of Congress clearing measures intended to lower some health care costs before the end of the year.

The deal — by Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, R-Tenn.; Energy and Commerce Committee Chairman Frank Pallone Jr., D-N.J.; and ranking member Rep. Greg Walden, R-Ore. — would prohibit health care providers from sending so-called “surprise medical bills” to patients that are inadvertently treated by an out-of-network doctor.

The lawmakers have not yet released the text of the agreement.

The three said in a statement that insurance companies and providers would determine payment through a new dispute resolution system that includes arbitration. The statement did not specify how arbitration, which has been the primary flashpoint in the debate, would be used.

“I do not think it is possible to write a bill that has broader agreement than this among Senate and House Democrats and Republicans on Americans’ number one financial concern: what they pay out of their own pockets for health care,” Alexander said. “Congress should pass the bill promptly and give the American people a very good Christmas present.”

Senate HELP Committee ranking member Patty Murray, D-Wash., did not sign on to Sunday’s announcement, but a spokeswoman said she is working with the other lawmakers on a final agreement.

“Senator Murray believes the overall agreement takes important steps forward on a number of issues impacting patients and families, and is working with some members of her caucus on concerns they still have. She didn’t want to sign on to a press release until those were worked through,” said Helen Hare, her communications director.

The measure also would raise the legal age to purchase tobacco to 21, a priority for Senate Majority Leader Mitch McConnell, R-Ky. The bill includes provisions meant to lower prescription drug costs and would provide nearly $20 billion over five years in funding for community health centers, according to the joint statement.

“This agreement will make health care and prescription drugs more affordable for the American people,” Pallone said. “I’m hopeful that this bipartisan, bicameral agreement can be voted on quickly so that it can be signed into law before the end of the year.”

Ending surprise medical bills has been a bipartisan goal all year, but intense lobbying on how to determine payment had slowed the effort since both committees approved legislation over the summer.

Hospital and some physician trade groups have pushed to determine payment from insurers through baseball-style arbitration, while insurance companies and employer groups argued that they should pay a benchmark rate for a given geographic area. The White House had previously opposed using arbitration to resolve payment disputes, but reportedly okayed including some form of arbitration last week.

Today’s announcement did not detail how exactly payment would be determined, but lawmakers have been discussing setting a benchmark rate and allow an arbitration backstop in certain unresolved cases.

“We appreciate committee leadership for their work to progress efforts to end the practice of surprise medical billing, including by adding a simple arbitration safety valve to help providers and plans resolve these billing disputes,” Sens. Bill Cassidy, R-La., Maggie Hassan, D-N.H., and Michael Bennet, D-Colo., who had been pushing for an arbitration option, said in a statement. “As our discussions continue around the final details, we are encouraged that we’re one step closer to giving patients these vital protections.”

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