The House Committee on Education and the Workforce passed a number of bipartisan bills on July 12 aimed at bolstering transparency when it comes to health care pricing, while simultaneously lowering costs.
“Dishonest billing, opaque rules, and shady industry practices have left patients paying higher costs for health care,” committee Chairwoman Virginia Foxx (R-N.C.), who authored one of the bills, said in a statement announcing the comprehensive health care package Wednesday.
“Today’s passage of our bipartisan health care package makes great strides towards giving clarity to patients and building a health care system that is more transparent, affordable, and accessible,” Ms. Foxx added.
The first bill passed by lawmakers, H.R. 4509, or the “Transparency in Billing Act” would require group health plans and health insurance issuers to only pay claims submitted by hospitals that have in place policies that ensure they provide detailed and accurate billing.
Specifically, the legislation states that hospitals, as well as their off-campus outpatient locations, are required to implement what Republicans call “honest billing” including data such as unique health identifiers for the department where the item or service was provided.
The bill is authored by Ms. Foxx and Rep. Bobby Scott (D-Va.).
Bills a ‘Meaningful Step’ in Right Direction
Bill number two, H.R. 4507, or the “Transparency in Coverage Act,” would require insurers to make public certain data, including claims payment policies and practices, the number of claims denied, and periodic financial disclosures, in a timely and accurate manner.Beginning in January 2025, the legislation also prevents a group health plan, health insurers, or pharmacy benefit managers (PBMs) from entering into a contract with drug manufacturers, distributors, or wholesalers if they are unable to meet the transparency requirements or if the agreements will delay the disclosure of public information.
The third bill, H.R. 4508, or the “Hidden Fee Disclosure Act” strengthens requirements that PBMs and third-party administrators disclose compensation to plan fiduciaries.
Specifically, the legislation requires that patients receive transparent cost data regarding compensation for PBMs and third-party administrators to fiduciaries before receiving treatment.
Finally, H.R. 4527, or the “Health DATA Act,” works in tandem with the third bill by allowing plan fiduciaries to access and audit de-identified health claims data to ensure compensation paid by the plan is reasonable.
Failure to comply with the measure could result in a fine of up to $10,000 per day, according to the legislation.
In announcing the latest measures, Mr. Scott said transparency in health care is “essential for fostering meaningful competition” and called the latest bills a “meaningful step to shining a light on many of the commonplace, yet harmful, practices in the healthcare industry.”
Biden Tackles Medical Junk Fees
“Moreover, this package will help reduce costs for consumers and will help employers meet their obligation to ensure that their workers’ premium dollars are spent carefully,” he said. “The American people deserve to know the full picture of the prices they are asked to pay.”The latest bipartisan legislation comes after President Joe Biden last week unveiled a series of actions aimed at cutting health care costs and cracking down on “junk” insurance plans.
Those measures will also introduce new guidance, stemming from the 2020 No Surprises Act, to prevent surprise medical bills and tackle soaring medical debt tied to credit cards.
Announcing the measures—part of the president’s “Bidenomics” agenda—Mr. Biden said that junk fees related to health care cost Americans “hundreds of dollars a month,” making it harder for families to pay their bills.
“Today, my administration is closing these surprise billing loopholes,” Mr. Biden said. “Evading the law and playing games to charge patients outrageous prices has to end. It has to end.”
