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Congress Seeks to Address Rising Health Care Costs

Capitol Connector
Your source for the latest updates from Capitol Hill. We translate policy into practice so you can learn how policy trends will affect your work and how best to prepare.

Shelley Starkey

Congress Seeks to Address Rising Health Care Costs

May 30, 2019 | Drug Pricing | Medicare | Comments
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Both the House and Senate have released bipartisan proposals in the last week to lower out-of-pocket health care costs across the country. The Senate Health, Education, Labor, and Pensions (HELP) Committee has released a sweeping proposal to address surprise medical billing, increase transparency within the health care industry, and bring down drug costs. Meanwhile, leaders of the House Ways and Means and Energy and Commerce Committees are seeking input on draft legislation to cap out-of-pocket costs under Medicare Part D, the program’s prescription drug benefit.

SENATE HELP COMMITTEE PROPOSAL

The Lower Health Care Costs Act of 2019, still in a discussion draft, includes the following provisions:

  • Ending surprise medical bills with measures like requiring emergency health care to be charged according to patients’ in-network insurance benefits regardless if the care they received is from an out-of-network provider, benchmarking rates for services based on median payment rates in a geographic area, and requiring all individual providers within a hospital to accept the same insurance plans that the hospital accepts.
  • Lowering prescription drug costs by increasing competition between drug makers, educating providers and patients on similar generic drugs that can be substituted for more expensive brand name drugs when appropriate, and speeding up the drug development process by eliminating many barriers among drug patents and other loopholes.
  • Increasing transparency in the health care market with provisions to make health care costs readily available to patients before, during, and after receiving treatment, and requiring providers and insurers to provide quotes for services to allow patients to shop around.
  • Improving public health by increasing vaccination rates, expanding the use of technology-based health care models, providing guidance for localities to prevent obesity, and providing grants for states to reduce maternal mortality.
  • Allowing patients easier access to their health records with measures like giving them full electronic access to their own health claims information, increasing interoperability between various health information technology systems, and incentivizing health systems to keep patients’ health information private and secure.

“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,” said Senator Lamar Alexander (R-TN), Chairman of the HELP Committee. “We hope to move it through the health committee in June, put it on the Senate floor in July and make it law.”

More information on the specific provisions of the proposal are available by clicking here. The public is welcome to submit comments on the proposal via an email to LowerHealthCareCosts@help.senate.gov by 5pm on Wednesday, June 5.

HOUSE BILL ON MEDICARE PART D

A discussion draft from leadership on the House Way and Means and Energy and Commerce Committees looks to lower out-of-pocket prescription drug costs for Medicare Part D enrollees. The bill would create a cap for the amount of money enrollees would have to pay for their prescription drugs in a year, currently around $8,000, a number based on what’s known as the “catastrophic threshold.” It would also step down the federal government’s share of the catastrophic coverage from 80 percent to 20 percent over 4 years, a move meant to incentivize Part D plans to better manage costs by increasing their share of payments for high-cost drugs.

“We are unveiling a draft bipartisan proposal that would cap out-of-pocket expenses for seniors while also driving down costs for taxpayers,” said Ways and Means Committee Chairman Richard E. Neal (D-MA) and Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ), along with Ranking Members Kevin Brady (R-TX) and Greg Walden (R-OR) in a joint statement. “If enacted, this proposal would provide certainty to seniors that they will be protected should they need high-cost medications.”

Those hoping to provide feedback on the proposal can submit comments via an email to PartDImprovements@mail.house.gov by 5pm on Thursday, June 6. More information is available here.