The Senate Health, Education, Labor, and Pensions (HELP) Committee drafted legislation recently that would tackle health care costs, patient financial responsibility, unexpected medical expenses, and public health. Titled the Lower Health Care Costs Act of 2019, its goal is to improve the overall patient health care experience while reducing out-of-pocket patient spending.
HELP Committee Chairman and co-sponsor of the bill Senator Lamar Alexander (R-TN) delivered a statement explaining the group’s proposal. He describes the proposed legislation as “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.” Senator Alexander is hopeful the bill will hit the Senate floor for a vote in July and be signed into law.
The draft legislation has been a rare and welcome bipartisan effort, with both political parties working together to address key issues. The proposed legislation would tackle the following:
- Surprise medical billing. The bill would require out-of-network providers who practice in in-network facilities to accept those in-network rates, giving them the option of either contracting with the payer or going through the hospital for billing. A key element would involve price benchmarking with established prices for emergency services at out-of-network facilities as well as an arbitration process when a patient receives a surprise bill in excess of $750.
- High prescription drug costs. The bill emphasizes lowering the actual cost of drugs and providing patients with better access to and information on “biosimilars” (near-identical versions of products that can be manufactured once the patent expires) and generic drugs. Both offer the same medical benefit as original pharmaceuticals at a much lower cost and could help reverse the trend toward higher prescription drug prices.
- Health care transparency. The draft legislation focuses on health care price transparency and includes a number of provisions designed to inform patients, employers, and payers. These include creating a third-party non-government entity to sort through patient data in order to develop a price transparency database for patients, providers, and payers to use; an end to gag clauses that prevent patients and employers from seeing the true costs of care; banning anti-competitive terms in health insurance contracts; patient-centered hospital billing making it easier for patients to know how much each service costs; estimates from payers and providers; creation of a provider directory; and a ban on price spreading.
- Quality care standards. The draft bill would incorporate policies designed to improve the overall state of public health, including addressing lapses in vaccination rates; improving the telehealth experience; providing funding for programs addressing obesity; improving the infrastructure for notification of contagious diseases; and reversing maternal and infant mortality rates.
- Patient data access. The legislation proposes empowering patients by providing them with easier access to their medical records and requiring health care entities to focus more on protecting patient data and improving security.