Free Report on Lower Health Care Costs Act: A Critical Examination and Advocacy Statement for Enactment

Description

The bill advocates for changes in health care coverage, costs, and services. It applies in-network cost-sharing necessities to emergency and associated nonemergency health care services out of the network (Govtrack, 2020). The bill limits the charges by healthcare facilities and practitioners and forbids billing above the applicable in-network cost-sharing rate. It also revises some requirements to hasten the process of approving generics; it asserts that medical facilities and practitioners should give patients a list of services provided upon discharge, and bill for them in 45 days, and it limits the charges of Pharmacy Benefit Managers (PBMs) to insurers and cost of drugs to the insured (Govtrack, 2020). The bill also changes the minimum legal age to buy tobacco products from 18 to 21 years.

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Federal or State? Federal.

The bill was introduced in the 116th Congress (2019-2021) on 19 June 2019 by Lamar Alexander, a Republican senior senator for Tennessee. It is co-sponsored by Democrat Sen. Patty Murray, assistant senate minority leader and senator for Washington, and Sen. Joni Ernst, Senate Republican Conference vice chair and senator for Iowa (Govtrack, 2020).

Legislative Intent This bill intends to lower the costs of health care. it intends to lower these costs through five strategies as follows. First, to end surprise medical bills by protecting patients against out-of-network charges for emergencies, surprise bills, a benchmark for payment, use of effective date, and to cease surprise air ambulance charges among others. Second, to reduce prices of prescription drugs by modernizing Orange Book, prohibiting blockage of generic drugs, clarifying orphan drugs, streamlining the transition of biological products, and ensuring well-timed access to generics among others (S. 1895, 2019). Third, the bill intends to improve transparency in health care by forming a nongovernmental transparency organization, enhancing the precision of directory guidelines, and prohibiting anticompetitive terms in healthcare contracts that confine access to quality, low-cost care. Also, the bill intends to improve public health through strategies aimed at enhancing awareness of illness prevention, modernizing public health data, extending community health centers, and providing training to care, providers. Lastly, this bill intends to improve the exchange of health information by enhancing technical corrections and recognizing security practices, among others (S. 1895, 2019).

Proponents/Opponents Proponents

Although the Senate and the House of Representatives have yet to pass the bill, some of its proponents include Sen. Alexander and the co-sponsors, Senators Murray and Ernst. Alexander also noted massive support by the Health and Human Services (HHS) Secretary Alex Azar to the press, pleading with Congress to pass the bill to enhance American health care (Cunningham, 2019).

Opponents

Among the opponents of this bill is Kristy L. Webber, MD. Webber, the president of the American Association of Orthopedic Surgeons (AAOS) released a statement to oppose the provision of the bill to eradicate surprise medical bills claiming that the imposition of an insurer-controlled rate is not a viable solution. Webber posited that, unlike other proposals of the bill, insurers would not negotiate with practitioners or consider patient care circumstances, which would result in unilateral lower rates and lead to smaller insurance networks, fewer practitioners in rural areas, decreased healthcare competition, and reduced access to care in the country (Medical Device News Magazine, 2020). According to Webber, a better solution would be to give incentives to all parties to seek a reasonable agreement and allow the resolution of remaining disputes by a just arbitration process like the New York Model (Medical Device News Magazine, 2020).

Target Population

The target population for this bill is all Americans who seek both in and out-of-network health care services.

Status of the bill (Is it in hearings or committees?) The bill is in the committee stage. It was read twice and referred to the committee on Health, education, labor, and Pensions by the Senate on 19 June 2019. On 26 the same month, the committee ordered the bill to be reported with an amendment favorably like a substitute. On 7 August 2019, Sen. Alexander reported it with an amendment, without a written report, and on the same day, it was placed on the Senate legislative calendar number 133 under general orders (Congress, 2020).

General Notes/Comments

The Lower Health Care Costs Act mainly seeks to reduce the costs of health care. Affordability is one of the main factors of health care that countries across the globe pursue because it implies that citizens earning fewer wages can access care without financial strain. Should the bill be passed and enacted, substantive advancements will be realized in standardizing the costs of health care to reduce the heavy burden of rising costs of care on Americans. Enactment of this bill would also increase the number of Americans seeking health care services including mental care, therapies, substance abuse treatment, laboratory, and diagnostic care. Overall, this bill would significantly increase the quality of health care, and well-being of Americans, and enhance healthcare accountability.

Part 2: Advocacy Statement

There is a need to enact the Lower Health Care Costs Act to standardize the charges of care. A joint study conducted by the West Health Institute and the Naturally Occurring Retirement Community (NORC) at the University of Chicago in 2016 revealed that about 40% of Americans skipped medical tests or treatment in the past year because of cost, 32% were unable to complete prescription because of its cost (Benz et al. 2018). Moreover, more than half of Americans said they had received a medical bill they thought would be covered by insurance or where the amount they owed for care was higher than they expected, and four out of ten said they feared costs associated with severe illnesses, which exceeds the number of said they fear the illnesses themselves (Benz et al. 2018). If enacted, the bill would significantly reduce the cost of care by first, ending surprise medical bills for emergency care like an air ambulance. Patients are not prepared for surprise bills, and since they are not covered under insurance, they often strain the victims, limiting their access to quality and efficient care.

Furthermore, this bill should be passed because it aims at reducing the prices of prescription drugs and improving public health. With lower charges for prescription drugs, more patients will be able to complete their prescriptions and complete their treatments to avoid the recurrence of their conditions and other complications that may result from incomplete prescriptions. Besides, this will also improve the general well-being of Americans because it will render more patients capable of completing their prescriptions thus improving the efficacy and outcomes of health care. Second, the bill targets to improve public health by modernizing public health data, training practitioners, and improving awareness of disease prevention. Improved public health will not only improve the overall outcomes of care, but it will also dismiss public perceptions and myths in the communities. By enhancing public health this bill will not only facilitate public education on disease prevention but also on how diseases are spread, which will reduce infections.

Lastly, this bill would enhance transparency in health care and improve the exchange of health information. Increased healthcare transparency is beneficial to a wide range of stakeholders including patients, employers, health plans, care providers, and policymakers (ACP, 2010). Transparency builds trust in the patient-physician relationship and healthcare system, and it improves the quality, safety, and efficacy of care because of competition and the availability of clinical benchmarks (ACP, 2010). Moreover, enhanced health information exchange would help a better quality of care and patient outcomes by minimizing medication and medical errors; it would also improve community health by enhancing coordination between various healthcare stakeholders. Overall, the Lower Health Care Costs Act should be passed and enacted to increase the affordability and effectiveness of care.

References

Benz, J., Titus, J., Tompson, T., & Leitz, S. (2018). Americans’ Views of Healthcare Costs, Coverage, and Policy. NORC at the University of Chicago. https://www.norc.org/PDFs/WHI%20Healthcare%20Costs%20Coverage%20and%20Policy/WHI%20Healthcare%20Costs%20Coverage%20and%20Policy%20Issue%20Brief.pdf

Congress. (2020). S. 1895-Lower Health Care Costs Act. Congress.gov. https://www.congress.gov/bill/116th-congress/senate-bill/1895/all-actions?overview=closed#tabs

Cunningham, P. W. (2019). Health 202: Congress cannot get its act together on lowering drug prices or eliminating surprise medical bills. The Washington Post. https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2019/12/10/the-health-202-congress-can-t-get-its-act-together-on-lowering-drug-prices-or-eliminating-surprise-medical-bills/5deebc7a88e0fa51665bf0e5/

GovTrack. (2020). S.1895: Lower Health Care Costs Act. GovTrack. https://www.govtrack.us/congress/bills/116/s1895/summary

Lower Health Care Costs Act S. 1895. (2019). 116th Congress 1st Session: S. 1895-To Lower Health Care Costs. Govinfo. https://www.govinfo.gov/content/pkg/BILLS-116s1895rs/pdf/BILLS-116s1895rs.pdf

Medical Device News Magazine. (2020). AAOS Opposition Statement to Senate HELP Surprise Billing Proposal. Informeddnews. https://infomeddnews.com/aaos-opposition-statement-to-senate-help-surprise-billing-proposal/