[Congressional Record Volume 165, Number 109 (Thursday, June 27, 2019)]
[Senate]
[Pages S4622-S4624]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      LOWER HEALTH CARE COSTS ACT

  Mr. ALEXANDER. Mr. President, I ask unanimous consent that a copy of 
my opening statement at the Senate

[[Page S4623]]

Health Education, Labor and Pensions Committee be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                      Lower Health Care Costs Act

       Mr. ALEXANDER. Today we are voting on three bills:
       First, the Poison Center Network Enhancement Act, offered 
     by Senators Murray and Burr, to reauthorize and update the 
     national network of poison control centers.
       Second, the Emergency Medical Services for Children Program 
     Reauthorization Act, offered by Senator Casey and me, to 
     ensure that, from the ambulance to the emergency room, 
     emergency health care providers are fully prepared to treat 
     children, who typically require smaller equipment and 
     different doses of medicine .
       Third, the Lower Health Care Costs Act--a package of 54 
     proposals from 65 senators--29 Republican and 36 Democrat, 
     including nearly every member of this Committee--that will 
     reduce what Americans pay out of their own pockets for health 
     care.
       The Lower Health Care Costs Act will reduce what Americans 
     pay out of their pockets for health care in three major ways: 
     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 
     (PBM) 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 lower-cost generic and biosimilar drugs reach patients.
       This legislation also extends mandatory funding for 
     community health centers, and four additional public health 
     programs, to ensure the 27 million Americans who rely on 
     these centers for primary care and other health care can 
     continue to access care close to home, offered by Senator 
     Murray and me, along with Senators Casey, Cramer, Klobuchar, 
     and Murkowski.
       We have paid for this extension for five years with savings 
     from other parts of the larger bill, which will prevent the 
     uncertainty and anxiety of short-term extensions.
       The Managers Amendment we are voting on today includes two 
     additional, significant provisions: First, a bill from 
     Senators McConnell and Kaine that will raise the minimum age 
     for purchasing any tobacco product from 18 to 21. This has 
     also been a priority of Senators Young, Romney, Roberts, 
     Murkowski, Collins, Schatz, and others.
       And two, from Senators Grassley and Leahy, and many others, 
     the CREATES Act, which will help bring more lower cost 
     generic drugs to patients by eliminating anti-competitive 
     practices by brand drug makers.
       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.
       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.
       Over the last two years, this Committee has held 16 
     hearings on a wide range of topics related to reducing the 
     cost of health care--specifically, how do we reduce what the 
     American people pay out of their own pockets for health care.
       Last December, I sent a letter to experts at the American 
     Enterprise Institute and the Brookings Institution, and to 
     doctors, economists, governors, insurers, employers, and 
     other health care innovators, asking for specific steps 
     Congress could take to lower the cost of health care.
       We received over 400 recommendations, some as many as 50 
     pages long. In May, Senator Murray and I released for 
     discussion the Lower Health Care Costs Act. Since then, we've 
     received over 400 additional comments on our draft 
     legislation, and last Tuesday, we held a hearing to hear 
     additional feedback.
       Last Wednesday, Senator Murray and I formally introduced 
     the Lower Health Care Costs Act--a bipartisan package of 54 
     proposals from 65 senators that will reduce what Americans 
     pay out of their own pockets for health care.
       At our hearing on this legislation last week, Ben Ippolito, 
     an economics and health fellow at the American Enterprise 
     Institute, said:``Together, the provisions in this bill would 
     meaningfully increase competition and transparency in health 
     care markets. If enacted, this legislation would lower 
     insurance premiums and drug prices for consumers, and would 
     ensure patients are no longer exposed to surprise medical 
     bills. By lowering costs, this bill would also improve access 
     to health care.''
       We also heard from Fredrick Isasi, Executive Director of 
     Families USA, at our hearing, who said:``The Reducing Lower 
     Health Care Costs Act is an ambitious piece of legislation--
     particularly so as a bipartisan bill in these most 
     contentious of times.''
       And Avik Roy recently wrote in Forbes:
       ``Overall, its provisions could be thought of as 
     incremental in scope. But some--especially those around 
     transparency--could have a significant impact.''
       Here are a few of the ways this legislation will lower 
     health care costs:
       Ensures that patients do not receive a surprise medical 
     bill--which is when you unexpectedly receive a $300 bill, or 
     even a $3,000 bill, two months after our surgery, because one 
     of your doctors was outside of your insurance network.
       Senators Cassidy, Hassan, and Murkowski have done valuable 
     work to solve surprise medical billing by proposing a 
     solution last fall and again this spring, and lighting a fire 
     under Congress to end this harmful practice.
       I thank them for their dedication to this issue, and for 
     working with Senator Murray and me to reach a result that 
     protects patients.
       Senator Murray and I have agreed on a recommendation to our 
     colleagues that the best solution to protect patients from 
     surprise medical bills is to pay doctors and hospitals that 
     are out-of-network the median contracted rate that in-network 
     doctors and hospitals receive for the same services in their 
     local geographic area, known as the benchmark solution.
       This is a change for me because I was inclined to support 
     an in-network guarantee since I believe it is the simplest 
     solution.
       Some of my colleagues are inclined to support a new 
     independent system of dispute resolution, known as 
     arbitration. The Congressional Budget Office has indicated 
     that the benchmark solution is the most effective at lowering 
     health care costs and Chairman Pallone and Ranking Member 
     Walden have recommended this proposal to the House of 
     Representatives.
       We have also extended this protection to air ambulances, 
     because according to the Government Accountability Office, 
     nearly 70 percent of air ambulance transports were out-of-
     network in 2017 and the median price charged by air ambulance 
     providers was about $36,400 for a helicopter transport and 
     $40,600 for a fixed-wing transport.
       It is time to stop studying the issue of exorbitant air 
     ambulance charges and take action.
       Our legislation will treat air ambulances the same as 
     health care providers--by using the local, commercial market-
     based rate for in-network health care.
       This legislation will bring more generic and biosimilar 
     drugs to market faster and lower the cost of prescription 
     drugs by: Helping biosimilar companies speed drug development 
     through a transparent, modernized, and searchable patent 
     database. Senators Collins, Kaine, Braun, Hawley, Murkowski, 
     Paul, Portman, Shaheen, and Stabenow worked on this 
     provision.
       Improves the Food and Drug Administration's drug patent 
     database by keeping it more up to date--to help generic drug 
     companies speed product development, a proposal offered by 
     Senators Cassidy and Durbin.
       Prevents the abuse of citizens' petitions that can 
     unnecessarily delay drug approvals, from Senators Gardner, 
     Shaheen, Cassidy, Bennet, Cramer, and Braun.
       Clarifies that the makers of brand biological products, 
     such as insulin, are not gaming the system to delay new, 
     lower cost biosimilars from coming to market, from Senators 
     Smith, Cassidy, and Cramer; and Eliminates a loophole that 
     allows drug companies to get exclusivity--and delay less 
     costly alternatives from coming to market--just by making 
     small tweaks to an old drug, a proposal from Senators 
     Roberts, Cassidy, and Smith.
       Modernizes outdated labeling of certain generic drugs, 
     offered by Senators Bennet and Enzi.
       This legislation creates more transparency by:
       Banning gag clauses that prevent employers and patients 
     from knowing the true price and quality of health care 
     services. This proposal from Senators Cassidy and Bennet 
     would allow an employer to know that a knee replacement might 
     cost $15,000 in one hospital and $35,000 at another hospital;
       Requiring health care facilities to provide a summary of 
     services when a patient is discharged from a hospital to make 
     it easier to track bills, and requires hospitals to send all 
     bills within 45 calendar days to protect patients from 
     receiving unexpected bills many months after care, a 
     provision worked on by Senators Enzi and Casey; and
       Requiring doctors and insurers to provide patients with 
     price quotes on their expected out-of-pocket costs for care, 
     so patients are able to shop around, a proposal from Senators 
     Cassidy, Young, Murkowski, Ernst, Kennedy, Sullivan, Cramer, 
     Braun, Hassan, Carper, Bennet, Brown, Cardin, Casey, 
     Whitehouse, and Rosen.
       It will support state and local efforts to increase 
     vaccination rates, and will help prevent disease outbreaks, 
     through two proposals worked on by Senators Roberts, Peters, 
     and Duckworth.
       There is a provision to help communities prevent and reduce 
     obesity, offered by Senators Scott and Jones.
       A provision from Senators Schatz, Capito, Cassidy, Collins, 
     Heinrich, Hyde-Smith, Kaine, King, Murkowski, and Udall will 
     expand the use of technology-based health care models to help 
     patients in rural and underserved areas access specialized 
     health care.
       And there is a proposal to improve access to mental health 
     care led by Senators Cassidy and Murphy, building on their 
     work in the HELP Committee that became law as part of the 
     response to the opioid crisis.

[[Page S4624]]

       There are other proposals:
       For example, banning anti-competitive terms in health 
     insurance contracts that prevent patients from seeing other, 
     lower-cost, higher-quality providers. The Wall Street Journal 
     identified dozens of cases where anti-competitive terms in 
     contracts between health insurers and hospital systems 
     increase premiums and reduce patient choice.
       Banning Pharmacy Benefit Managers, or PBMs, from charging 
     employers, health insurance plans, and patients more for a 
     drug than the PBM paid to acquire the drug, which is known as 
     ``spread pricing.''
       Eliminating a loophole allowing the first generic drug to 
     submit an application to the FDA and block other generic 
     drugs from being approved.
       Provisions to improve care for expectant and new moms and 
     their babies.
       Provisions to make it as easy to get your personal medical 
     records as it is to book an airplane flight.
       And provisions to incentivize health care organizations to 
     use the best cybersecurity practices to protect your privacy 
     and health information.
       I hope we will today vote to approve this legislative 
     package so we can present it to Majority Leader McConnell and 
     Minority Leader Schumer for the full Senate to consider next 
     month and would expect that other committees will have their 
     own contributions.
       Since January, Senator Murray and I have been working in 
     parallel with Senator Grassley and Senator Wyden, who lead 
     the Finance Committee.
       They are working on their own bipartisan bill, which they 
     plan to markup this summer. The Senate Judiciary Committee is 
     marking up bipartisan legislation on prescription drug costs 
     tomorrow. And in the House, the Energy and Commerce, Ways and 
     Means, and Judiciary Committees have all reported out 
     bipartisan bills to lower the cost of prescription drugs.
       Secretary Azar and the Department of Health and Human 
     Services have been extremely helpful in reviewing and 
     providing technical advice on the various proposals to reduce 
     health care costs.
       And the president has called for ending surprise billing 
     and reducing the cost of prescription drugs. The 
     Administration has also taken steps to increase transparency 
     so families and employers can better understand their health 
     care costs. The Lower Health Care Costs Act is just one 
     example of this Committee reaching a result on a difficult 
     issue.
       We did that with fixing No Child Left Behind, with the 21st 
     Century Cures Act, with user fee funding for the Food and 
     Drug Administration, and most recently, with our response to 
     the opioid crisis that included input from 72 senators of 
     both political parties.
       We reached those results in the midst of the argument 
     Congress has been locked in for the last decade about where 
     six percent of Americans get their health insurance.
       Especially for Americans without subsidies, the cost of 
     health insurance remains way too expensive. But the reality 
     is we will never have lower cost health insurance until we 
     have lower cost health care.
       That is why I am especially glad that 65 Senators, 
     including nearly every member of this Committee, have worked 
     together on the Lower Health Care Costs Act which takes 
     needed steps to actually bring down the cost of health care 
     that Americans pay for out of their own pockets.

                          ____________________