[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.
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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.
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