Update: Lowering Health Care Costs Act of 2019

Monday, July 8, 2019

The Senate Committee on Health, Education, Labor and Pensions (HELP) advanced bipartisan legislation to lower health care costs with a 20-3 vote on June 26, 2019. This legislation included fifty-four proposals made by sixty-five senators. The Lowering Health Care Costs Act of 2019, likely to be combined with health bills added from the Judiciary and Finance Committees, is predicted to make it to the Senate floor mid to late July, before the month-long recess in August.

The National Health Council (NHC) applauds the committee for their continuous efforts to help reduce the financial burden from increasing out-of-pocket (OOP) costs for health care products and services placed upon patients. After the original draft was introduced, the NHC submitted comments that showed support of the legislation, but also raised concerns about potential unintended consequences. We have written about our comments on the discussion draft in a previous blog post. This post provides an update on the legislation.

Update: Surprise Medical Billing

The discussion draft included three options for financial compensation from an insurer to a provider when a beneficiary receives out-of-network care in an in-network facility. Importantly, all three options would ensure the person receiving the care would not pay more for their “surprise bill.” The legislation that was voted out of the HELP Committee adopts the benchmark approach. This approach, which is supported by insurers but opposed by providers, will allow insurers to pay the median in-network rate when a patient sees a provider that is out-of-network while receiving treatment in an in-network facility. This proposal would end the practice of balance billing and will enforce doctors and hospitals to accept a set rate for services when there is a dispute over billing.

Added Amendments:

  1. The Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2019 was added to the bill. The CREATES act is designed to foster competition of drugs and biological products in the market and will prohibit anti-competitive practices in generic drug development. The NHC has supported this legislation.
  2. The Fair Accountability and Innovative Research (FAIR) Drug Pricing ACT was also incorporated into the bill. The objective of this act is to enforce transparency by requiring drug makers to report when they raise the prices of their drugs and provide reasoning for increasing the costs. The NHC has supported a similar concept in our recommended proposals to reduce health care costs.
  3. The Tobacco-Free Youth Act, originally introduced by Senators McConnel and Kaine, was also adopted into the bill. This provision will raise the legal sale of tobacco from age eighteen to twenty-one.

Other Concerns:

The NHC is still concerned over the Committee’s decision to remove requirements that make biologic products adhere to US Pharmacopeia (USP) public quality standards. The committee should withdraw or provide justification for removing this provision.

The NHC remains heartened by Congress and the Trump Administration for their efforts in reducing health care costs that financially cripple many patients. We thank the HELP Committee for their bipartisan efforts and hope the interests of patients will be a top priority with the advancement of this bill.