Speaker Nancy Pelosi (D-Calif.) met with three Democratic committee chairmen on Monday in an effort to bridge differences between competing plans to protect patients from surprise medical bills, but there was no breakthrough, according to people familiar with the meeting.  

The meeting comes as backers of a solution are making a last-ditch push to try to include the protections in the upcoming coronavirus response package. But amid a complex array of divisions across the parties and lobbying by powerful industries, the proposal faces very tough odds of making it into the package, despite both sides of the aisle and the White House saying they support the idea in principle. 

Pelosi met in her office with Energy and Commerce Chairman Frank Pallone Jr. (D-N.J.), Education and Labor Chairman Bobby Scott (D-Va.) and Ways and Means Chairman Richard Neal (D-Mass.). 

The idea is to protect patients from getting stuck with surprise medical bills for thousands of dollars when they get care from a doctor who happens to be outside their insurance network. 

The proposal has been stalled since last year, though, given intense lobbying from various parts of the health care industry over the details of how much insurers would pay doctors once the patient is protected. 

Pallone and Scott are both backing an approach that also has the support of the top Republicans on their committees and the bipartisan leaders of the Senate Health Committee. That bill is also backed by consumer groups and unions who say it would do more to drive down health care costs and lower premiums for consumers. 

Neal is pushing a rival approach, along with Rep. Kevin Brady (R-Texas), the top Republican on his committee, warning that Pallone and Scott's approach would lead to damaging cuts to payments to hospitals and doctors. 

Backers of the first approach have grown frustrated with Neal for what they view as an unwillingness to budge and a desire simply to derail the process. 

Asked about the meeting, Neal spokeswoman Erin Hatch warned that the Pallone and Scott proposal would hurt hospitals as they are dealing with coronavirus and pointed to statements of support from hospital groups for Neal's bill. 

"I know you’re well-aware of the horrible impact COVID-19 has had on doctors and community hospitals," Hatch wrote in an email. "A proposal that favors big insurance companies and their bottom lines over the survival of critical health care providers isn’t good for patients, especially right now.”

She added, though, that “Chairman Neal left the conversation optimistic — everyone in the meeting was committed to addressing the issue in the near future, and progress was made during the discussion.”

Neal’s stance on surprise billing has become an issue in his primary race against a progressive challenger, Alex Morse, as well. The progressive group Fight Corporate Monopolies began running an ad earlier this month accusing Neal of blocking progress on surprise billing to protect private equity companies like Blackstone, which is a contributor to him. Private equity firms own doctor staffing companies that would take a financial hit from surprise billing legislation. 

More broadly, though, it is unclear if any of the top four congressional leaders, in both parties, will push for inclusion of surprise billing legislation in the upcoming package, leaving its future looking bleak. 

Pelosi still faces a divide among her chairmen and has so far not been willing to overrule either side to reach a deal. And Senate Majority Leader Mitch McConnell (R-Ky.) has not expressed any interest in dealing with the issue. 

The Trump administration did release a report from the Department of Health and Human Services on Wednesday calling for congressional action on the issue, without endorsing a specific approach. 

“Now it’s time for Congress to do what we all agree is necessary: combat surprise billing with an approach that puts patients in control and benefits all Americans,” HHS Secretary Alex Azar said in a statement on Wednesday. 

Pallone and Scott also released a statement with their panels’ two top Republicans, Reps. Greg Walden (R-Ore.) and Virginia Foxx (R-Va.) and Senate Health Committee leaders Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) calling for action on their approach on Wednesday. 

“The American people can’t afford to wait any longer,” the statement said.