Lawmakers Push Measures to Promote Competition in Healthcare Sector


Editor’s note: Today, the Chief Healthcare Executive® launches a new series examining legislation that may affect hospitals and healthcare systems.

From left, Sen. Tammy Baldwin, Sen. Mike Brown, and Rep. Michelle Steele (pictures from the Senate and House offices)

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Lawmakers say the bipartisan bill would cut health care costs and curb some anti-competitive behavior by the large health care system.

sponser

Sen. Tammy Baldwin, Democratic Wisconsin. Senator Michael Brown, Indiana Republican. US Congressman Michelle Steele (Republican from California).

summary

Proponents of the bill, dubbed the “Sound Competition Act for Better Health Care,” claim they will curb anti-competitive practices in the health care sector.

Legislators backing the bill argue that it would give insurance companies and employers more freedom to contract the right hospital for their patients without having to contract with other affiliated hospitals or providers. are doing.

Lawmakers say hospitals and health insurers will have more freedom to negotiate prices without having to pay exorbitant prices for other insurers’ services and products. The bill allows exceptions for health maintenance organizations (HMOs) and value-based networks.

Lawmakers are trying to introduce similar measures in 2019 and 2021, which received some support but failed to pass parliament.

what they say

Steele said the bill would prevent some hospitals from stifling competition.

“Health care costs have risen steadily for decades, leaving millions of Californians with devastating medical debt,” Steele said in a statement. “This law addresses the root cause of the problem by empowering the free market to naturally lower prices. Hospitals can no longer be allowed to exclude competitors or hide prices from patients. “

Baldwin emphasized the benefits of promoting competition and changing practices in the larger healthcare system.

“No American should go bankrupt to pay for the health care they need. I’ve seen it,” Baldwin said in a statement. “Our legislation will crack down on the anti-competitive behavior of major health care systems to increase transparency, reduce costs, and provide more Wisconsin people with the quality care they need.”

Continuing the theme, Brown also mentioned the benefits of creating more competition.

“Competition is key to creating competitive markets that increase choice and transparency while reducing costs that ultimately benefit consumers. To improve, we should encourage natural and healthy competition of all kinds,” Brown said in a statement.

supporter

The US Benefits Board strongly supported the bill. The council’s senior vice-president for health policy, Irise Schumann, said this would reduce costs. “The only way to effectively bring down healthcare costs is to address the root causes of rising prices, such as anti-competitive contracts that impede choice and competition,” Schumann said in her statement.

The ERISA Industrial Committee, also known as ERIC, supports the bill. ERIC President and CEO James Gelfand said in a statement, “This bill will increase competition and reduce integration within the health care system, making it a safer place for employers, workers and their families. It’s a core tenet for making healthcare affordable.”

The USA family and small business majority also support the bill.

perspective

Congress appears to be more interested in measures to promote competition in health care, an initiative that has drawn support from both Democrats and Republicans.

Some lawmakers and supporters are promoting a “facility-neutral” policy, which means hospital outpatient departments and clinics are reimbursed equally by Medicare. Hospitals argue that lowering reimbursement rates for outpatient facilities could undermine patient access to quality care. These clinics, they argue, are treating more patients from underserved areas and those with more complex medical conditions.

The Biden administration has also focused on promoting competition, including by applying greater oversight to hospital mergers involving systems within the same region. The Federal Trade Commission is also trying to repeal non-compete agreements that hospitals oppose. Hospitals say ending these deals would be a game-changer, especially for hospital executives and doctors.



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