[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.