Republican Sen. Lamar Alexander and Democratic Sen. Patty Murray introduced a draft legislative package Thursday to lower healthcare costs by ending surprise medical billing, enhancing transparency in pricing of health services, and lowering prescription drug costs.
Alexander and Murray, who represent Tennessee and Washington, respectively, and often are successful at reaching bipartisan compromise through leading the Health, Education, Labor, and Pensions Committee, released a series of ideas for senators to weigh in on during the coming weeks and hope to have a measure sent to President Trump by July.
The portion aimed at surprise medical bills — which refer to instances in which patients get unexpected medical charges, often after going to the emergency room or undergoing surgery — includes a proposal that health plans pay a medical facility a price in line with the median contracted rate in that particular area.
Another idea would be to have practitioners and insurers, in cases where a surprise bill is above $750, resolve the cost of services by working with a third-party arbitrator to figure out what a fair price is. Through this measure, which does not have White House support, the patient would be removed from the complicated processes of fixing the dispute.
The draft would have providers and insurers disclose to patients exactly what services would cost before they receive procedures. Insurers would not be permitted to direct patients to use specific providers in contract with the insurers and thereby pushing patients to seek higher-priced care. Additionally, insurers would not be able to engage in an “all or nothing” approach to contract with all providers in a practice or no provider at all.
The draft suggests that a nongovernmental agency and public and private sector advisory committees could be responsible for informing providers, patients, and insurance plans, including Medicare, about the costs of healthcare and how to lower those costs.
The portion addressing prescription drugs suggests barring pharmacy benefit managers such as CVS Health from charging a patient or insurer any more for the drug than what it paid. Pharmacy benefit managers would give rebates directly to employer-provided plans or plans on the exchanges.
In an effort to further reduce prescription drug costs, apart from regulating pharmacy benefit managers, the Food and Drug Administration would have the authority to deny citizens petitions, which are requests to the FDA arguing for a monopoly over one drug by one manufacturer, often on behalf of the drug manufacturer, rather than allowing approval of generic alternatives and biosimilars. The idea would be to help generics enter the market faster and offer lower-cost alternatives to brand-name drugs.
Another portion of the bill deals with the rise in measles cases in the U.S. The proposal would have the Department of Health and Human Services launch an education campaign to tell people about the importance and safety of vaccines. The department would send grants to states so that health departments can update health data systems that track infectious disease cases in various communities and to help them more effectively provide parents in those communities with information about the safety of vaccines.
Finally, the plan includes ideas to improve the security of health information and to give patients better access to their medical records.
Alexander and Murray have worked together in the past on healthcare legislation, though not every effort has made it to the president’s desk. In 2017, they worked together on legislation to shore up Obamacare, but the bill lost support as Republicans and Democrats became divided over abortion language.
Kimberly Leonard contributed.
