US Senate takes on major health legislation

By Ben Keeton

In late June, Senator Alexander introduced a broad bill focused on lowering healthcare costs across the US. This legislation passed the Senate Health, Education, Labor and Pensions committee and if passed, will have implications across the healthcare sector in Kentucky.

The wide-ranging bill aims to tackle many issues including: surprise medical bills, healthcare transparency, competition in the drug industry, public health and advance the exchange of health information. One notable provision is that it would raise the nationwide tobacco purchasing age to 21, an initiative put forth by Senate Majority Leader McConnell.

The proposed legislation still has a long way to go, and many expect significant changes to occur. Over the next month, the Senate Finance Committee and Senate Judiciary Committee will markup a similar legislative package. Senate leadership hopes to merge the bills and have them on the Senate floor before the August recess.

Surprise Medical Billing

The bill addresses surprise medical billing by establishing a federal benchmark as the payment mechanism. The federal benchmark approach was chosen because the Congressional Budget Office said this method would be “the most effective at lowering healthcare costs.”

In the benchmark approach, health plans would pay providers the local median contracted commercial amount that insurers have negotiated with other providers and agreed upon in that geographic area.

Other legislators led by Senator Cassidy are pushing hard for the baseball style-arbitration solution. Several Senators and many providers believe that the proposed fix is entirely in the interest of insurance companies.

Chairman Alexander said he will work with Senator Cassidy on addressing some of the concerns in the bill before the package goes to the Senate floor.

Additionally, the legislation includes provisions about ending surprise air ambulance bills by using the local, commercial market-based rate for in-network healthcare.

An amendment was also adopted that requires hospitals to tell patients when their plan has no in-network providers for a certain service. The bill requires healthcare facilities to provide a summary of services when a patient is discharged from a hospital. It requires hospitals to send all bills within 45 calendar days to guard against unexpected bills and it requires insurers to provide patients with price quotes on their expected out-of-pocket costs for care.

The legislation extends funding through 2024 for critical healthcare programs, such as community health centers, teaching health centers operating graduate medical education programs and the National Health Service Corps. The measure aims to combat critical public health issues, such as vaccine misinformation and maternal mortality.