[Congressional Record Volume 165, Number 129 (Tuesday, July 30, 2019)]
[Senate]
[Pages S5165-S5167]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. ALEXANDER. Madam President, I often recommend to Tennesseans that 
they look at the U.S. Congress as if it were a split-screen television 
set.
  Here is what I mean by that. During the last month, on one side of 
the screen you saw the usual Washington, DC, turmoil--Trump versus the 
squad, Mueller testifying, impeachment votes, battle over the border, 
Presidential candidates posturing, and of course the daily tweets.
  On the other side of the screen was the President and congressional 
leaders agreeing to a 2-year budget that will strengthen our military, 
help our veterans, fund research for medical miracles, fund research 
for our National Laboratories, support our national parks, and save 
taxpayers a boatload of money by providing stability in funding.
  I might add that this part of the budget--31 percent of the budget--
is not the part of the budget that is creating the budget deficit. This 
part of the budget that we will be voting on tomorrow has gone up at 
about the rate of inflation for the last 10 years and is projected by 
the Congressional Budget Office to go up at about the rate of inflation 
for the next 10 years.
  It is the entitlement part of the budget that is the problem, which 
is why I am voting for what the President and the congressional leaders 
have recommended, but then also on that side of the screen, away from 
the Washington, DC, turmoil, there was another story, which is the 
story I want to talk about today.
  During that last same month, three Senate committees, by my count, 
made more than 80 bipartisan proposals, sponsored by at least 75 U.S. 
Senators of both political parties, to reduce the cost of healthcare 
that Americans pay for out of their own pockets.
  On June 26, after 17 hearings, 6 months of work, recommendations from 
400 experts, our Health Committee, which I chair and of which Senator 
Patty Murray, the Democrat from Washington State, is the ranking 
member, voted 20 to 3 to recommend to the full Senate 55 proposals from 
65 Senators that would end surprise medical billing, increase 
transparency so you can know the cost of your medical care--you can't 
lower your healthcare costs if you don't know your healthcare actually 
costs--and increase competition to reduce the cost of prescription 
drugs.
  The next day after our Health Committee reported that legislation, 
the Judiciary Committee, headed by Senator Graham and Senator 
Feinstein, reported out 4 proposals from 19 Senators that would reduce 
prescription drug costs by banning anticompetitive behaviors by drug 
manufacturers and helping the Federal Trade Commission to block those 
who game the citizen petition process to delay generic drugs and 
biosimiliars.
  Then, last Thursday, the Finance Committee--this one headed by 
Senator Grassley and Senator Wyden--by a vote of 19 to 9, reported more 
than two dozen additional bipartisan proposals also aimed at reducing 
the cost of prescription drugs.
  That is not all. The House Energy and Commerce Committee has passed 
its own solution to surprise billing.
  Last Thursday, Senator Murray's staff and I met with Representatives 
Frank Pallone and   Greg Walden, the leaders of the House Energy and 
Commerce Committee. The four of us agreed to work together to lower 
healthcare costs.
  All of this work is consistent with what Secretary Azar and the 
President have been saying and doing to lower prescription drug costs 
and increase transparency.
  For example, last week, after the Finance Committee released its 
legislation, the White House said it ``is encouraged by the bipartisan 
work of Chairman Grassley and Senator Wyden to craft a comprehensive 
package to lower outrageously high drug prices, and today we are 
engaging with coalitions to help build support.'' That is from the 
White House.
  Here is why this amount of activity is, in so many ways, such a good 
sign for the American people. In our committee, what we have seen 
before with fixing No Child Left Behind, 21st Century Cures Act, last 
year's response to the opioid crisis--the last of which occurred, by 
the way, while on the other side of the split-screen television was the 
acrimonious Kavanaugh confirmation hearing--what we have seen with 
these recent new laws I just mentioned is that when that many Senators 
and that many Congressmen of both political parties go to work together 
on a big issue that affects millions of American people, there is 
likely to be a result that affects the American people.
  In other words, I believe legislation to end surprise medical 
billing, increase transparency, and lower prescription drug costs is 
looking like a train that will get to the station when Congress 
reconvenes in September, and well it should.
  The cost of healthcare is Americans' No. 1 financial concern, 
according to

[[Page S5166]]

Gallup, and at one hearing before our Health Committee, experts from 
the National Academy of Medicine testified that up to half of what our 
country spends on healthcare is unnecessary.
  That is such a startling fact that I sat down then with Senator 
Murray and with Senators Grassley and Wyden and with Senators Graham 
and Feinstein, and I said to the leaders of those committees: Surely, 
if the experts say that half of what we are spending is unnecessary, 
Democrats and Republicans can find some things we can agree on that 
reduce the cost of what we pay for healthcare out of our own pocket, 
and we have.
  The work of these three committees, more than 80 proposals from 75 
Senators, is the result of that work over the last 6 months.
  Let me say a word about perhaps the most visible proposal in the 
Health Committee's bill. Surprise medical billing is one of the most 
urgent problems that the House, the Senate, and the President are 
trying to fix.
  After about 20 percent of all emergency room visits, patients are 
surprised a few months later to receive an unexpected bill. It could 
range from $300 to $3,000 to $30,000. This happens because patients see 
a doctor they didn't choose, either because of emergency care at an 
out-of-network hospital or because an out-of-network doctor, not chosen 
by the patient, treats them at an in-network hospital.
  In his State of the Union Address and again at a White House event in 
May, President Trump called for an end to surprise billing. At the 
event, he gave me a copy of this medical bill, which we have enlarged 
on this chart. It was a bill sent to Liz Moreno, a Texas college 
student who had back surgery, and during a postsurgery followup visit, 
her doctor ordered a urine test. A year later, this bill showed up: 
$17,850 for a urine test. That is about the price of a new Nissan 
Sentra. The bill was sky high because the lab that ran the test--a lab 
Liz did not choose--was considered out of network by her insurer.
  Take Drew Calver, a Texan who told the President his story about 
getting $110,000 in bills--the emergency room he was rushed to during 
his heart attack was out of network and so were the doctors who treated 
him.
  That day, the President said: ``For too long, surprise billings . . . 
have left some patients with thousands of dollars of unexpected and 
unjustified charges. . . . So this must end.''
  The Lower Health Care Costs Act the Senate Health Committee passed 
last month by a vote of 20 to 3 would have protected Liz and Drew from 
receiving those surprise bills. Here is how it works: Insurance 
companies would pay out-of-network doctors a local, market-driven 
benchmark rate, which would be the same local, market-based rate that 
insurers negotiated with doctors who agreed to be in network. 
Obviously, this would have saved Liz and Drew because they wouldn't 
have gotten a surprise medical bill.
  The Congressional Budget Office says that by ending surprise medical 
billing, this approach would generally lower health insurance premiums. 
CBO also estimates that the approach would save taxpayers $25 billion 
over the next 10 years.
  Based on data from Kaiser, only about 5 percent of doctors at 10 
percent of hospitals send most of these surprise medical bills. So our 
solution primarily affects those doctors whom patients have little 
control over choosing--anesthesiologists, radiologists, pathologists, 
emergency room doctors, and neonatologists. It does not affect doctors 
whom a patient can choose, such as cardiologists or primary care 
doctors or pediatricians. In fact, the American Academy of Family 
Physicians, representing primary care doctors, supports our Lower 
Health Care Costs Act that ends surprise medical billing.
  Over the 17 hearings our Health Committee conducted in developing our 
legislation, we heard many stories about surprise billing. Here are a 
few.
  Todd, a Knoxville father who wrote me, took his son to the emergency 
room after a bicycle accident. Todd was surprised when a few months 
later he received a bill for $1,800--because, even though the emergency 
room was in network, the doctor who treated his son was not.
  Ahead of the birth of their first child, Danny and his wife Linda, 
from Georgia, chose an in-network doctor and hospital. Of course, they 
thought their insurance would cover their bills. When Luke was born 3 
weeks premature, he had to spend 11 days at the in-network hospital's 
neonatal care center. In the weeks after Luke went home, $4,279 in 
bills were sent to Danny and Linda because the neonatal care center, 
located in their in-network hospital, was out of network.
  Carrie Wallinger, from Phoenix, AZ, received a $9,000 surprise 
medical bill after going to an in-network emergency room after her dog 
bit her finger. The doctor who came to stitch up her finger was from an 
out-of-network facility, and so she got an unexpected $9,000 surprise 
bill.
  A South Carolina woman who had to have an emergency C-section 
received a $15,000 bill from an out-of-network anesthesiologist.
  Usually when you are being wheeled into an emergency room for an 
emergency operation, you are not thinking about choosing a doctor, and 
you are not interviewing them about whether they are in network or out 
of network.
  In Texas, after an ATV crushed his arm, Dr. Naveed Khan, a 
radiologist, needed advanced medical care. The cost of a 108-mile trip 
in an out-of-network helicopter cost $44,631.
  Nicole Briggs, from Colorado, had emergency surgery to remove her 
appendix at an in-network hospital. She owed $4,727 because the surgeon 
was out of network.

  In Mississippi, Stacy White took her husband to the emergency room at 
an in-network hospital. The emergency physician who saw her husband was 
out of network, and to her surprise, they received a bill for $2,700.
  West Coz, a 3-year-old with a 107-degree fever, was airlifted from a 
small community in West Virginia to a more advanced hospital 75 miles 
away. His parents were left with a $45,000 bill for the helicopter.
  In Maine, the State representative who sponsored a bill to protect 
patients against surprise bills received a several-hundred-dollar bill 
himself because the radiologist who read his daughter's x-ray was out 
of network even though he took his daughter to an in-network hospital.
  There are many more stories I could tell, but the bottom line is, in 
each case, this happened because the patient almost always had little 
choice. If you don't have choice, then you really don't have a 
functioning market. It is a market failure.
  One reason for the uptick in surprise bills is that this market 
failure is now being exploited by private equity firms. Oftentimes, 
hospitals will contract with a company to staff their emergency rooms 
and hospitals. These companies will handle billing, manage schedules, 
and hire doctors to staff the hospital emergency room.
  Here is some research done by Yale economist Zack Cooper. He found 
that two of the leading staffing companies--both backed by private 
equity firms--significantly increase the rate of out-of-network billing 
in a hospital once the firms are hired.
  In the case of one of the physician staffing companies that Cooper 
studied, a large insurer's data showed that the cases of surprise 
billing increased by 100 percent at six different hospitals once this 
physician staffing firm took over those hospitals' emergency rooms.
  In a New York Times article, Cooper described the 100-percent jump in 
surprise bills once these private equity-backed staffing companies 
entered by saying it was ``almost . . . like a light switch was being 
flipped on.''
  In Axios, Cooper said: ``If you're willing to engage in some fairly 
unsavory billing practices, (these services) could be quite lucrative. 
. . . That's just discouraging, and it makes people want to go to 
single payer.'' These surprise bill abuses make Americans want to go to 
single payer.
  Our goal is to protect patients, not private equity firms and 
companies that are taking advantage of patients. Surprise medical bills 
are one of the most visible problems for the 180 million Americans who 
get their health insurance on the job.
  When growing numbers of patients are receiving surprise medical bills 
that could bankrupt their families, it is time for Congress to act. If 
Congress can't fix such an obvious market failure in healthcare, 
pressure will only grow for a radical Federal takeover of healthcare 
that will take away private insurance from the 180 million Americans 
who get insurance on the job and

[[Page S5167]]

leave patients with less choice, fewer doctors, and worse healthcare.
  Avik Roy wrote in Forbes that ``if we do nothing [to address surprise 
medical bills], the problem will get far worse. If we do something that 
is too incremental, we'll pat ourselves on the back and then be forced 
to revisit the problem in a few years. Americans deserve market-based 
alternatives to single-payer health care. Without reform of exploitive 
hospital prices, we'll never get there.''
  Americans want to be mindful consumers of healthcare. When Todd, the 
Knoxville father, wrote me, he said: ``If I'm expected to be a 
conscientious consumer of my own health care needs, I need a little 
more help.'' In other words, he needs for Congress to end surprise 
medical bills.
  It is unacceptable to say to patients that, even by paying their 
premiums every month, even by researching and choosing in-network 
hospitals and doctors, they may be on the hook for thousands of 
unexpected dollars because of a surprise bill over which they had no 
control.
  At least 75 Senators and the President of the United States have made 
it clear that our intent is to end surprise billing and to reduce what 
Americans pay out of pocket for their healthcare. When Congress 
reconvenes in September, I would encourage all of my colleagues to 
support these efforts to reduce healthcare costs.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.