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Jurisdictional infighting and intense lobbying from industry ultimately scuttled Congress' efforts to deal with surprise medical bills this year.

Why it matters: Surprise bills were about as close to a slam-dunk as Congress gets in health policy, and lawmakers' failure to get such an easy thing across the finish line doesn't bode well for other, harder priorities.

What happened: Key lawmakers — Sen. Lamar Alexander and Reps. Frank Pallone and Greg Walden, who lead the Energy and Commerce Committee — announced a deal on the issue earlier this month.

  • Senate Minority Leader Chuck Schumer was concerned about the impact on New York hospitals, but he told other congressional leaders that he wouldn't oppose the deal's inclusion in the year-end spending bill.

After that deal was announced, House Ways and Means Chairman Richard Neal announced a separate agreement with Ranking Member Kevin Brady.

  • That put the two committees with jurisdiction over surprise bills on different pages.
  • Democratic leaders opted not to pick a side by including surprise bills in a year-end legislative package.

“There’s nothing diabolical about it, or nefarious," Neal told Axios. "We were simply saying, 'time to vet it.' The idea that you were just going to attach this to a spending bill and send it over without that opportunity? I mean, I think that would have been ill-considered.”

What's next: A House leadership aide said they'll try again, with another must-pass bill next spring.

The bottom line: "In an environment where all constituents of all parties are demanding relief from health care cost and complexity, the Democrats should be wary about singing the song of affordability concerns without delivering the goods," said Democratic health consultant Chris Jennings.

Go deeper

1 hour ago - World

Army to award Purple Hearts to troops injured in Iran missile attack

Damage at Ain al-Asad military airbase housing U.S. and other foreign troops in the western Iraqi province of Anbar in January 2020. Photo: Ayman Henna/AFP via Getty Images

The Army has approved 39 more Purple Hearts for U.S. soldiers wounded in an Iranian military ballistic missile attack on an Iraq base in January 2020, the Army Times first reported Wednesday.

Why it matters: Most of these soldiers sustained brain injuries, per the Army Times. Then-President Trump dismissed their injuries at the time as "headaches" and "not very serious," sparking backlash from some veterans groups.

Scoop: U.S. begins denying Afghan immigrants

Afghan refugees on a bus bound for temporary housing after arriving in Greece. Photo: Byron Smith/Getty Images

The Biden administration has begun issuing denials to Afghans seeking to emigrate to the United States through the humanitarian parole process, after a system that typically processes 2,000 applications annually has been flooded with more than 30,000.

Why it matters: Afghans face steeper odds and longer processes for escaping to the U.S., despite the earlier sweeping efforts by the Biden administration to assist its allies. Immigration lawyers and advocacy groups say the government has set untenable barriers to a safe haven in the U.S.

4 hours ago - Politics & Policy

Dems invoke Robert Byrd to sell Manchin on Senate rules changes

Photo illustration: Shoshana Gordon/Axios. Photos: Diana Walker, Chip Somodevilla/Getty Images

A small group of Senate Democrats is privately invoking the legacy of late West Virginia Sen. Robert Byrd in an effort to sway Sen. Joe Manchin (D-W.Va.) to support their plans to change the chamber's rules, Axios has learned.

Why it matters: Manchin — who holds Byrd's Senate seat — has often referenced his predecessor's strong moral conviction and insistence on preserving the Senate as an institution, as justification for some of his tough positions.