AHA comments on Senate HELP draft bill on reducing health care costs

June 5, 2019

RE: Discussion Draft Legislation on Reducing Health Care Costs

Dear Chairman Alexander and Ranking Member Murray:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners – including more than 270,000 affiliated physicians, 2 million nurses and other caregivers – and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to provide feedback on the Lower Health Care Costs Act of 2019, the Committee’s bipartisan discussion draft legislation. We applaud the efforts the Committee has taken to address this important issue.

The cost – and affordability – of health care in America affects all stakeholders, including patients and their families, employers, policymakers and care providers. And all stakeholders play a role in making care and coverage more affordable. Hospitals and health systems understand the importance of this issue and have been tackling it head on, taking steps to redesign care and implement operational efficiencies.

One important step we can take to address the affordability of care for patients is to end surprise bills. We commend your focus on this issue, and we look forward to continuing to work with you to find a solution to protect patients and remove them from the middle of any reimbursement disputes. Our preferred solution is simple: patients should not be balance billed for emergency services, or for services obtained in any in-network facility when the patient could reasonably have assumed that the providers caring for them were in-network with their health plan. Patients should have certainty regarding their cost-sharing obligations, which are based on an in-network amount. We strongly oppose the imposition of arbitrary rates on providers, along with untested proposals such as bundling payments, which would significantly increase complexity in the system and may, ultimately, be unworkable. We encourage the Committee to use this opportunity to help simplify the health care system rather than add more complexity.

We are pleased that the committee proposes making important investments in public health, including efforts to modernize the public health data system and improve maternal health outcomes. We also are supportive of provisions aimed at increasing competition in the prescription drug market and ensuring patient access to these drugs. We appreciate the Committee’s focus on the importance of ensuring the privacy and security of patient health information and are pleased the draft legislation would incentivize strong cybersecurity practices.

However, we are concerned about several of the proposals that would allow the government to intrude into private commercial contracts between providers and insurers. For example, several of the provisions could undermine value-based purchasing arrangements aimed directly at improving the quality of care while reducing costs. We strongly urge the Committee to remove these provisions.

We appreciate the opportunity to provide these comments and support the Committee's efforts and attention to examining the cost of health care in America. We are committed to working with Congress, the Administration and other health care stakeholders to ensure that all individuals and families have the health care coverage they need to reach their highest potential for health.

Our specific comments on the discussion draft legislation are as follows.

Sincerely,

Thomas P. Nickels
Executive Vice President