Lawmakers in the House and Senate are working together on legislation Senator Lamar Alexander (R-TN) describes as a “Christmas present” to America. Patients will be able to know the costs of medical care before it is administered.
“I do not think it is possible to write a bill that has broader agreement than this one does among Senate and House Democrats and Republicans on Americans’ number one financial concern: what they pay out of their own pockets for healthcare,” said Alexander.
The Lower Health Care Costs Act introduces arbitration, a system for dispute resolution designed to protect patients when insurance companies disagree with providers.
In cases where patients receive emergency out-of-network care, providers would be paid based on a benchmark rate that matches the average rate for in-network care in that region. Providers can appeal charges to an independent arbitrator only if those charges exceed $750 and would be prohibited from bundling charges.
What this means for patients: they won’t pay any more money for out-of-network emergency care than they would for in-network care and they won’t be subject to “balance billing,” when a patient is charged the full difference between what an insurer is willing to pay for an out-of-network provider and what that provider wants to charge.
The deal, with support from the Trump Administration, could save the government nearly $20 million.
The Lower Health Care Costs Act also includes five years of funding for community health centers, introduces a new measure to increase transparency and competition for prescription drugs, and addresses the vaping epidemic by increasing the minimum age to buy tobacco products to 21.
Lawmakers hope to attach the bill to a spending package due December 20th.
Author’s Note: This is a major step forward in getting Americans in charge of their own healthcare. And its bipartisan.