People cutouts with stethoscopeThe bill's novel “in-network guarantee” would require thatany hospital considered “in-network” for a health plan must promisethat everyone working there is also in-network. (Photo:Shutterstock)

|

In a year already marked by a wide variety of congressionalhealth care legislation, Sens. Lamar Alexander (R-Tenn.) and PattyMurray (D-Wash.), the chair and ranking Democrat of the Health,Education, Labor and Pensions Committee, on Thursday released thedetails of a plan they hope can help bring down health costs andeliminate surprise medical bills for patients.

|

“These are common sense steps we can take, and every single oneof them has the objective of reducing the health care costs thatyou pay for out of your own pocket,” Alexander said in a statement.“We hope to move it through the health committee in June, put it onthe Senate floor in July and make it law.”

|

It would be a mammoth piece of legislation, targeting nearlyevery area of the health care industry for reform, includingsurprise medical bills, prescription drugs, transparency, publichealth and health information. Alexander said at a White Houseevent earlier this month that he hopes to get the package to theSenate floor by the end of July.

|

Related: Forget Medicare for All, Americans want help withhealth care expenses

|

“When you have a chairman and a ranking member that have workedtogether on a bipartisan package in the committee of jurisdiction,it always gives more weight to the product,” said Dean Rosen aformer Republican senior health adviser and a partner at MehlmanCastagnetti Rosen & Thomas.

|

“Folks should take this package seriously,” he added.

|

The draft bill released by the senators offers three options tocurb surprise bills, those unexpected and oftenpricey bills patients face when they get care from a doctor orhospital that isn't in their insurance network. It would use anindependent arbitrator to settle disputes between insurance plansand providers and set a standard benchmark for physician pay, ideasthat have popped up in other draft legislation circulating in theHouse and Senate.

|

The novel part from Alexander and Murray is the idea of an“in-network guarantee.” It requires that any hospital considered“in-network” for a health plan must promise that everyone workingthere is also in-network.

|

This would avoid situations in which patients choose a hospitalbecause they know their insurance company will cover the bill, onlyto find out that one of the doctors they saw was out-of-network,leaving the patient with a hefty bill.

|

It also requires that labs and diagnostic tests be in-network,cutting off another avenue of surprise bills.

|

“From a policy perspective, there's a rationale that this is theideal approach,” said Loren Adler, the associate director ofUSC-Brookings Schaeffer Initiative for Health Policy.

|

Often called “network matching,” it's an approach championed bythe health insurance industry. James Gelfand, senior vice presidentfor health policy for the ERISA Industry Committee, named itspecifically as a solution during testimony at a surprise bill hearing in the House Ways andMeans Committee on Tuesday. Rep. Lloyd Doggett (D-Texas) hassuggested something similar in bills introduced in this session andtwo past congresses.

|

It's possible that this option will upset provider groups, whorisk receiving lower payments and having less leverage withinsurance companies. Adler said these fears are mostly unfoundedbecause hospitals have a vested interest in being fully staffed;they'll step in if insurance companies try to lowball doctors.

|

Stakeholders such as industry trade groups, lobbyists andconsultants will get a chance to air those concerns at a closedbriefing on the draft on Capitol Hill Thursday.

|

The Alexander-Murray proposal joins an array of efforts onsurprise billing. The White House held an event featuring patients, several Housecommittees have held hearings, and bipartisan groups in the Houseand Senate have proposed legislation, including a bill from Sens.Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.). In addition toAlexander and Murray's proposal, the details of another bipartisanbill were released Thursday from Rep. Raul Ruiz (D-Calif.) and Rep.Phil Roe (R-Tenn.), both also physicians.

|

But Alexander and Murray's proposal also covers a wide array ofissues, and it's not clear how that will play in Congress just afew months from the start of a presidential election season.

|

“The steps we are taking on important issues like surprisemedical billing, drug prices, maternal mortality, and vaccinehesitancy show we can make progress when both sides are at thetable ready to put patients and families first,” said Murray.

|

“I think it is an ambitious package,” Rosen said. “I think it'sprobably going to be a challenge to get all of this done.”

|

The Alexander-Murray proposal also tackles prescription drugpricing reform, another issue that has raised bipartisan concernsand spurred hearings across the Capitol this spring.

|

Instead of regulating drug prices, the package would addresspatent protections, making it easier for generics to get tomarket and harder for brand-name drugs to maintain exclusivepatents for lengthy periods.

|

It also addresses pharmacy benefit managers, which have latelycome under scrutiny in the drug pricing debate. PBMs act asmiddlemen between drugmakers and insurance plans to negotiateprices and have been blamed by some in the pharmaceutical industryfor keeping medication costs high.

|

The proposal suggests requiring PBMs to give quarterly reportson costs, fees and information about rebates — which are thediscounts drugmakers offer to PBMs in exchange for making suretheir medication is covered under a health plan. The bill alsorequires that 100% of these discounts be passed on toconsumers.

|

Other provisions include requiring health plans and providers togive patients estimates of out-of-pocket-costs for a service within48 hours of a request and mandating that medical bills be sentwithin 30 days of a procedure.

|

The bill addresses a host of other health-related issues,including some making headlines recently:

  • Money for programs to educate people about vaccines andprograms to reduce vaccine-preventable diseases.
  • Grants to study and improve maternal mortality and improvepregnancy and postpartum care.
  • Money for better training for health care professionals toprevent discrimination and bias.
  • Measures to improve privacy and cybersecurity for healthinformation and electronic medical records.

Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with Kaiser Permanente.

|

Read more: 

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com