Senate Health, Education, Labor, and Pensions (HELP) Chair Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) May 23 released the Lower Health Care Costs Act of 2019, a bipartisan discussion draft aimed at reducing health care costs. The draft focuses on five key areas: ending surprise medical bills, reducing prescription drug costs, increasing transparency, improving public health, and enhancing health information technology (HIT).
In a joint press release, Senators Alexander and Murray both emphasized the bipartisan nature of this proposal. Alexander stated, “Republicans and Democrats in the United States Senate have announced this proposal of nearly three dozen specific bipartisan provisions that will reduce the cost of what Americans pay for health care. 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.” Murray added, “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.”
This discussion draft builds upon recent efforts in both chambers of Congress to address surprise medical bills [see Washington Highlights, May 17] by proposing three different options to ensure that patients would only be held harmless and required to pay the in-network amount — whether they receive emergency services or inadvertently receive out-of-network care. The first option requires all practitioners at an in-network hospital to provide in-network care to patients. Providers would be able to join the insurance networks that cover that hospital or can choose to send the bill through the hospital rather than sending separate bills to the patient or insurer.
The second option would benchmark services so that insurance companies would pay providers the median contracted rate for services provided in that geographic area. The final option provides for arbitration. For surprise bills over $750, the insurer or provider would both submit their best offer to an independent arbiter to make a final decision on the price to be paid.
The discussion draft also includes nine sections aimed at reducing the cost of prescription drugs. The text suggests several approaches including: increasing availability of patent and exclusivity information for drugs and biologics through submission of information to the Health and Human Services Secretary and publication in the Orange Book and Purple Book; adding additional clarification for products that will transition from the Food and Drug Administration’s (FDA) “drugs” to “biologics” pathway classification in March 2020; introducing language to restrict exclusivity protections for generics and new chemical entities; and requiring the FDA to provide education on biologics to the public via a website and to health care providers through Continuing Medical Education opportunities.
Several sections reflect bills already introduced in the 116th Congress, including the Biologic Patent Transparency Act (S. 659), the Ensuring Timely Access to Generics Act of 2019 (H.R. 2455 / S. 1169), the Protecting Access to Biosimilars Act of 2019 (H.R. 2011 / S. 1140), and the House-passed Orange Book Transparency Act of 2019 (H.R. 1503) [see Washington Highlights, May 10].
Additionally, the proposal seeks to improve transparency in the health care market in a number of ways, including directing a nongovernmental, nonprofit entity to use de-identified patient health care data so patients, states, and employers can better understand health care costs and take steps to reduce those costs.
Other key provisions of the draft legislation seek to increase vaccination rates and prevent disease outbreaks, expand the use of technology-based health care models, reduce maternal mortality rates, and enhance HIT to give patients full access to their own health claims information and incentivize health care systems to keep personal health information private and secure.
The HELP Committee is requesting feedback on this draft proposal by Wednesday, June 5. According to Chairman Alexander, the Committee plans to mark up the legislation by the end of June.