June 21, 2019

Senate HELP Committee Assesses Bill to Lower Health Care Costs

The Senate Committee on Health, Education, Labor & Pensions met June 18 to discuss policy proposals included in the “Lower Health Care Costs Act,” a bipartisan bill spearheaded by Chairman Lamar Alexander and Ranking Member Patty Murray.

Although the bill is intended to reduce health care costs overall and includes provisions relating to drug prices and increasing health care transparency, much of the discussion during Tuesday’s hearing focused on the issue of surprise medical billing. Despite the hearing’s expanded focus, the witness testimony and subsequent dialogue with lawmakers yielded no new substantive policy developments or recommendations to address the out-of-network billing issue.

Perhaps the most interesting insight of the day was Chairman Alexander’s acknowledgment that his preferred policy resolution for surprise billing is “network matching,” whereby providers would be required to be in network with every payer for which the hospital is contracted.

The American College of Radiology (ACR) opposes this concept as a solution for surprise medical billing. Network matching may appear to be an easy solution to “fix the market failure” some high-profile think tanks attribute to the increase in surprise billing. However, network matching is an entirely unproven method for addressing these issues.

Many physicians choose to navigate the increasingly bureaucratic and onerous requirements put in place by insurers to participate in as many networks as possible. Moreover, there are many benefits for physicians to be in-network, such as predictable reimbursement and less administrative burden. However, requiring all health care providers credentialed at a hospital to contract with identical plans distorts the contracting dynamic by completely removing a physician group’s ability to negotiate a contract. In these cases, the insurer would know the hospital already has the contract and would, therefore, have little incentive to negotiate in good faith with individual providers or provider groups.

As a result, the College continues to urge lawmakers to embrace a comprehensive approach that pairs an initial payment with the independent dispute resolution (IDR) process, such as outlined in S. 1531, the STOP Surprise Medical Bills Act. However, the ACR has urged the bill’s sponsor to adjust the initial payment to reflect a “commercially reasonable rate."

Barring scheduling delays, the committee will meet again on June 26 to “mark up” the Lowering Health Care Costs Act. In the interim, the ACR Government Relations team is working with relevant Senate offices on possible amendments for the bill and will provide additional information as it becomes available.

Witness testimony is available below and a playback of the full hearing is available here.

  • Sean Cavanaugh, MPH – Chief Administrative Officer, Aledade
  • Benedic N. Ippolito, Ph.D. – Research Fellow, American Enterprise Institute
  • Tom Nickels – Executive Vice President, American Hospital Association
  • Elizabeth Mitchell – President and Chief Executive Officer, Pacific Business Group on Health
  • Frederick Isasi, JD, MPH – Executive Director, Families USA
  • Marilyn Bartlett – Special Projects Coordinator for the Commissioner of Securities and Insurance, Office of the Montana State Auditor