Health Care Costs Legislation Moves Toward Committee Consideration; Includes Patient Protections > Hospital Association of Pennsylvania

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Health Care Costs Legislation Moves Toward Committee Consideration; Includes Patient Protections

June 20, 2019

The U.S. Senate Health, Education, Labor and Pensions (HELP) Committee took steps this week to advance a package of policies aimed at addressing health care costs—including a policy to protect patients from surprise medical bills.

The HELP Committee held a hearing on Tuesday to formally consider feedback offered by health care stakeholders about draft legislation—the Lower Health Care Costs Act— that had been introduced in late May. On Thursday, Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) introduced S. 1895, the Lower Health Care Costs Act of 2019, and scheduled a mark-up of the legislation for June 26.

The bill presents policy solutions seeking to reduce the cost of what Americans pay for health care by:

  • Addressing surprise medical bills
  • Targeting prescription drug prices
  • Increasing transparency
  • Improving public health
  • Facilitating the exchange of health information

Importantly, the legislation would protect patients from surprise medical bills by ensuring patients only are responsible for the in-network cost-sharing amount for out-of-network care in certain circumstances—such as emergency care or where a patient may not reasonably know a provider is out-of-network.

In a June 5 letter to the HELP Committee offering feedback on the original discussion draft, HAP expressed support for efforts to protect patients from surprise medical bills consistent with principles laid out by the American Hospital Association (AHA). HAP did urge careful consideration of policies that interfere with private contractual negotiations and impose new requirements that are not ultimately meaningful to patients.

Of concern, in the newly introduced legislation, S. 1895, the HELP Committee has adopted an approach to resolve payment disputes between a provider and a health plan by setting a benchmark rate. The rate is based on the median contracted in-network rate for services in the geographic area.

In testimony before the HELP Committee, Tom Nickels, Executive Vice President of the AHA, stated:

Our preferred solution is simple: Patients should not be balance billed for emergency services, or for services obtained in any in-network facility when the patient could reasonably have assumed that the providers caring for them were in-network with their health plan. In these situations, patients should have certainty regarding their cost-sharing obligations, which should be based on an in-network amount. Once the patient is protected, hospitals and health systems should be permitted to work with health plans on appropriate reimbursement.

The U.S. House Energy & Commerce Committee released its own bipartisan discussion draft—The No Surprises Act—in mid-May to address patients’ exposure to unexpected medical bills and held a legislative hearing last week. The AHA submitted comments responding directly to the No Surprises Act discussion draft, and provided testimony during the hearing. Both communications to the Committee emphasized opposition to setting a rate in law, which would stand to disrupt local market forces in ways that could have significant negative unintended consequences. Those consequences include creating a disincentive for health plans to maintain adequate networks and act as good business partners to their providers.

Other legislative proposals being discussed in Congress would resolve disputes between insurers and providers over reimbursement for out-of-network care using an arbitration model.

HAP will continue to provide input to members of the Pennsylvania Congressional delegation as policy proposals take shape and move through the legislative process, consistent with the key priority of ensuring patients are taken out of the middle of standard negotiations between insurers and health care providers.

If you have questions, please contact Jeff Becthel, HAP’s senior vice president, health economics and policy, or Laura Stevens Kent, HAPs vice president, federal advocacy.

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