Don Treeger/The Republican via AP
Supporters outside the studio where Rep. Richard Neal and his challenger, Holyoke Mayor Alex Morse, met in a televised debate, August 17, 2020, in Springfield, Massachusetts
If Holyoke Mayor Alex Morse defeats Rep. Richard Neal in the Democratic primary in Massachusetts’s First Congressional District, it doesn’t mean that Democrats will pass a decent health care law under a President Biden. But Neal winning re-election almost guarantees they won’t.
Neal is the chairman of the incredibly powerful House Ways and Means Committee, and has truly terrible positions on health care. On the most pressing issues, he is arguably to the right of most Democrats, many Republicans, and even President Trump. His track record of using his position to stop popular bipartisan reforms suggests he would create major hurdles for health care advances of any kind. More importantly, his victory would send the worst possible signal to lobbyists, big corporate donors, and other members of Congress.
If you or anyone you know received a surprise medical bill in the past year, you have Richie Neal to thank. Surprise billing is the practice where someone receives a large out-of-network bill from a medical provider, even when they intended to go to an in-network facility. It has spawned one of the most ghoulish business practices in American health care. Private equity–backed companies have been buying up physician groups in fields where people have no choice who their provider is, like air ambulances and emergency rooms, to charge unsuspecting patients obscene amounts. Even if you haven’t received a surprise bill, you are still a victim of this abuse. These companies use the threat of surprise billing to demand dramatically higher prices from employers and insurance companies, and that is passed on to you in the form of higher premiums.
The practice is so abhorrent and generates so many terrible headlines that polling shows 89 percent of voters want Congress to put an end to it, a number without parallel in Congress. Many congressional Democrats and Republicans have actively worked to end it, and even President Donald Trump actually has pushed for a solution.
There are ideological, practical, and financial disagreements over how to determine a “fair” price when a person is treated out of network, which is why this terrible practice has been allowed to fester. After years of work by policy experts and activists, last December Democrats and Republicans finally worked out a deal. The problem was almost solved, until Neal used his power as chairman to step in at the last minute to single-handedly kill it, after receiving massive donations from the private equity firms responsible for much of the surprise billing.
The practice is so abhorrent and generates so many terrible headlines that polling shows 89 percent of voters want Congress to put an end to it.
The way to kill extremely popular reform is not to say you oppose it in principle, but to raise process concerns. You ask for more studies or a special committee, and you pick a fight over the details. You delay and delay and delay until there is no time left because a more pressing issue, like a global pandemic, comes up. This is what Neal did, but he did it in the most ham-fisted and transparently cynical way imaginable. Just as a deal was reached, out of nowhere, Neal put out a counterproposal—except it wasn’t even a well-crafted, innovative counterproposal that made people rethink the logic of the current deal. It was just a vague, one-page outline, co-authored by his Republican counterpart on the Ways and Means Committee, which basically just signaled that he intended to sink the current deal to force everyone to start negotiations all over again. It was the most pathetic fig leaf, allowing Neal to run cynical ads claiming he supported fixing surprise billing, while being solely responsible for delaying reform until Congress ran out of time.
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With Neal as Ways and Means chair defending the worst actors in American health care, passing real reform would be difficult. Neal doesn’t just take money from private equity firms with surprise billing practices, but from insurance companies, pharmaceutical companies, and practically every business with an interest in health care. There are ways the party could work around him; other committees of jurisdiction could be handed the reins for a reform bill. The message his victory would send, however, could be the death knell for any real reform. If members of Congress can survive claiming to support popular reform while so clearly trying to kill it with cynical ploys, there is little hope for progress. It would signal there is no betrayal of the voters’ will that you can’t get away with as long as you offer some fig leaf.
Sen. Joe Lieberman (I-CT) was eventually made a pariah among Democrats by actively coming out against the public option in 2009, but a Neal victory would show that Lieberman’s mistake was purely one of messaging. Lieberman could have just said he supported the public option in principle, but thought it needed more study and more work on the details. If Neal wins, every lobbyist and big corporate donor will point to Neal as their poster child and model. It would serve as proof you can do their bidding, take their money, oppose one of the most popular reforms in the country, and still get credit for pretending to care as long as you say the right things.
