|You might favor this bill if:
► You believe that health care costs should be lowered. There should be a reduction in the prices of prescription drugs, and an improvement in transparency when it comes to health care. Also, there should be more investments in public health and an improvement in health information exchange.
|You might oppose this bill if:
► You believe that lowering the cost of health care will lead to a reduction in the quality of healthcare provided. The current healthcare laws protecting patients already work.
The Lower Health Care Costs Act helps to prevent surprise medical bills, reduce prescription drug prices, improve transparency in health care, invest in public health and improve health information exchange.
Surprise billing occurs when a patient receives care from an out-of-network provider without knowing the provider was out-of-network or without the ability to choose an in-network provider.
Laws to protect patients from surprise billing, including the Lower Health Care Costs Act, typically limit the cost-sharing for patients to the amount they would have paid if they had been cared for by an in-network provider.
This cost-sharing is also typically applied to their deductible and out-of-pocket payment limits that also apply to in-network care.
The more difficult considerations include how to ensure that the out-of-network provider gets appropriate compensation from the insurer for the care delivered to the patient when there is no contract between that provider and the insurer.
The draft of the Lower Health Care Costs Act includes three options to address the problem of surprise billing.
The first option requires that hospitals guarantee in their contracts with a health plan that each health care practitioner who provides services in the facility will be under contract as a participating provider and that all diagnostic and laboratory services provided in the facility will be included in the contract.
Under this option, providers can choose whether to be reimbursed directly from the health plan or through the hospital.
The second option in the bill establishes an independent dispute resolution (IDR) process whereby each party, the hospital or provider and the insurer, each submit their final offer of what they think is a reasonable reimbursement rate to an IDR entity.
The third and final option in the draft of the Lower Health Care Costs Act sets a benchmark rate at the median contracted rate for "a similar service that is provided by a provider in the same or similar specialty and in the geographic region in which the service is furnished.
The Lower Health Care Costs Act would advance several provisions that improve health care affordability and access.
For example, it would protect millions of patients from surprise medical bills, with well-considered approaches to control health care costs for everyone.
It would encourage more competition from generic drugs to lower drug prices. It also would clear the way for consumers to get more of their health information, more timely bills, and accurate cost estimates before they seek care.
“The Lower Health Care Costs Act will reduce what Americans pay out of their pockets for health care in three major ways," said Chairman Lamar Alexander.
"First, it ends surprise billing. Second, it creates more transparency.
There are twelve bipartisan provisions that will eliminate gag clauses and anti-competitive terms in insurance contracts, designate a non-profit entity to unlock insurance claims for employers, ban Pharmacy Benefit Managers (PBMs) from charging more for a drug than the PBM paid for the drug, and require that patients receive more information on the cost and quality of their health care.
You can't lower your health care costs until you know what your health care actually costs.
And third, it increases prescription drug competition - there are fourteen bipartisan provisions to help more low cost generic and biosimilar drugs reach patients.”
"Altogether, this legislation will help to lower the cost of health care, which has become a tax on family budgets and on businesses, on federal and state governments," Alexander continued.
"A recent Gallup poll found that the cost of health care was the biggest financial problem facing American families. And last July, this committee heard from Dr. Brent James, from the National Academies, who testified that up to half of what the American people spend on health care may be unnecessary."