The
ambitious bill is targeting nearly every area of the health care industry for
reform
by Rachel Bluth /
Kaiser Health News | May 24, 2019
In a year already
marked by a wide variety of congressional health care legislation, Sens. Lamar
Alexander (R-Tenn.) and Patty Murray (D-Wash.), the chair and ranking Democrat
of the Health, Education, Labor and Pensions Committee, on Thursday released the
details of a plan they hope can help bring down health costs and eliminate
surprise medical bills for patients.
It
would be a mammoth piece of legislation, targeting nearly every area of the
health care industry for reform
“These are common
sense steps we can take, and every single one of them has the objective of
reducing the health care costs that you pay for out of your own pocket,”
Alexander said in a statement. “We hope to move it through the health committee
in June, put it on the Senate floor in July and make it law.”
It would be a mammoth
piece of legislation, targeting nearly every area of the health care industry
for reform, including surprise medical bills, prescription drugs, transparency,
public health and health information.
Alexander said at a
White House event earlier this month that he hopes to get the package to the
Senate floor by the end of July.
“When you have a
chairman and a ranking member that have worked together on a bipartisan package
in the committee of jurisdiction, it always gives more weight to the product,”
said Dean Rosen a former Republican senior health adviser and a partner at Mehlman
Castagnetti Rosen & Thomas.
“Folks should take
this package seriously,” he added.
The draft bill released by the senators offers three options
to curb surprise bills, those unexpected and
often pricey bills patients face when they get care from a
doctor or hospital that isn’t in their insurance network.
It would use an
independent arbitrator to settle disputes between insurance plans and providers
and set a standard benchmark for physician pay, ideas that have popped up in
other draft legislation circulating in the House and Senate.
In-network guarantees
The novel part from
Alexander and Murray is the idea of an “in-network guarantee.” It requires that
any hospital considered “in-network” for a health plan must promise that
everyone working there is also in-network.
It
also requires that labs and diagnostic tests be in-network, cutting off another
avenue of surprise bills.
This would avoid
situations in which patients choose a hospital because they know their
insurance company will cover the bill, only to find out that one of the doctors
they saw was out-of-network, leaving the patient with a hefty bill.
It also requires that
labs and diagnostic tests be in-network, cutting off another avenue of surprise
bills.
“From a policy
perspective, there’s a rationale that this is the ideal approach,” said Loren
Adler, the associate director of USC-Brookings Schaeffer Initiative for Health
Policy.
Often called “network
matching,” it’s an approach championed by the health insurance industry. James
Gelfand, senior vice president for health policy for the ERISA Industry
Committee, named it specifically as a solution during testimony at a surprise bill hearing in the House Ways and
Means Committee on Tuesday.
Rep. Lloyd Doggett
(D-Texas) has suggested something similar in bills introduced in this session
and two past congresses.
Provider group
challenges
It’s possible that
this option will upset provider groups, who risk receiving lower payments and
having less leverage with insurance companies.
Adler said these
fears are mostly unfounded because hospitals have a vested interest in being
fully staffed; they’ll step in if insurance companies try to lowball doctors.
Stakeholders such as
industry trade groups, lobbyists and consultants will get a chance to air those
concerns at a closed briefing on the draft on Capitol Hill Thursday.
The Alexander-Murray
proposal joins an array of efforts on surprise billing. The White House held an event featuring patients, several
House committees have held hearings, and bipartisan groups in the House and
Senate have proposed legislation, including a bill from Sens. Bill Cassidy
(R-La.) and Maggie Hassan (D-N.H.).
In addition to
Alexander and Murray’s proposal, the details of another bipartisan bill were
released Thursday from Rep. Raul Ruiz (D-Calif.) and Rep. Phil Roe (R-Tenn.),
both also physicians.
But Alexander and
Murray’s proposal also covers a wide array of issues, and it’s not clear how
that will play in Congress just a few months from the start of a presidential
election season.
“The steps we are
taking on important issues like surprise medical billing, drug prices, maternal
mortality, and vaccine hesitancy show we can make progress when both sides are
at the table ready to put patients and families first,” said Murray.
“I think it is an
ambitious package,” Rosen said. “I think it’s probably going to be a challenge
to get all of this done.”
Tackling prescription
drugs
The Alexander-Murray
proposal also tackles prescription drug pricing reform, another issue that has
raised bipartisan concerns and spurred hearings across the Capitol this spring.
Instead of regulating
drug prices, the package would address patent protections, making it easier for generics to get to
market and harder for brand-name drugs to maintain exclusive patents for lengthy
periods.
It also addresses
pharmacy benefit managers, which have lately come under scrutiny in the drug
pricing debate. PBMs act as middlemen between drugmakers and insurance plans to
negotiate prices and have been blamed by some in the pharmaceutical industry for
keeping medication costs high.
The proposal suggests
requiring PBMs to give quarterly reports on costs, fees and information about
rebates — which are the discounts drugmakers offer to PBMs in exchange for
making sure their medication is covered under a health plan. The bill also
requires that 100% of these discounts be passed on to consumers.
Other provisions
include requiring health plans and providers to give patients estimates of
out-of-pocket-costs for a service within 48 hours of a request and mandating
that medical bills be sent within 30 days of a procedure.
Vaccines and other
issues
The bill addresses a
host of other health-related issues, including some making headlines recently:
·
Money
for programs to educate people about vaccines and programs to reduce
vaccine-preventable diseases.
·
Grants
to study and improve maternal mortality and improve pregnancy and postpartum
care.
·
Money
for better training for health care professionals to prevent discrimination and
bias.
·
Measures
to improve privacy and cybersecurity for health information and electronic
medical records.
This KHN story first published on California
Healthline, a service of the California Health Care Foundation.
Kaiser Health News is a nonprofit news
service covering health issues. It is an editorially independent program of the
Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
No comments:
Post a Comment