The Lower Costs, More Transparency Act, poised for a House vote, promises transformative changes in healthcare. Advocating for transparency and banning spread pricing in Medicaid, it navigates bipartisan territories. However, opinions diverge on its immediate effectiveness. Advocacy groups, like the US of Care and NCPA, commend its strides toward fairness in pricing. Yet, opposition from hospital associations raises concerns about patient access and funding disparities. The bill’s delay and potential reemergence highlight the complexities of bipartisan support. Despite uncertainties, the Act signifies a crucial step in healthcare reform, addressing transparency, pricing, and access issues in a multifaceted landscape.
The imminent House vote on the Lower Costs, More Transparency Act heralds a potential revolution in healthcare dynamics. Crafted to enhance transparency, reform pricing structures, and extend federal programs, this legislation emerges from the convergence of three House committees. Advocacy groups and organizations, while acknowledging its strides toward fairness, express reservations about immediate effectiveness. The Act’s contentions revolve around disparities in funding for hospitals and concerns about patient access. This legislation, delayed and anticipated to resurface, underscores the intricate nature of bipartisan support and the multifaceted challenges in reforming healthcare for equitable access and fair pricing.
Lisa Hunter, the senior director for policy and external affairs at US of Care—an advocate for affordable and equitable healthcare—highlighted the significance of this multi-committee effort. She acknowledged that while the bill might not encompass every desired aspect for all stakeholders, she views the transparency regulations as a pivotal initial stride towards healthcare reform, particularly beneficial for the average person.
The National Community Pharmacists Association (NCPA), emphasizing their 2023 legislative priorities, advocated for the prohibition of spread pricing in Medicaid managed care programs. Additionally, they endorsed the notion of reimbursements tied to the state’s Medicaid fee-for-service dispensing fee, rooted in the Centers for Medicare & Medicaid Services’ national average drug acquisition costs survey, aiming to enhance transparency in drug pricing.
Families USA Executive Director Frederick Isasi expressed the necessity for transparency, asserting that every family deserves to be informed about hospital charges before receiving medical care. However, there are differing opinions on the effectiveness of the bill once implemented. Michael Strazzella of Buchanan Ingersoll and Rooney suggested that the transparency provisions might not offer an immediate solution to reducing prices, emphasizing the complexities in consumer decision-making even with enhanced transparency measures.
Hunter perceived the Lower Costs, More Transparency Act as a culmination of bipartisan interest in reforming healthcare, drawing inspiration from successful state-level laws across politically diverse states. She specifically highlighted the momentum behind site-neutral payment reforms and fairer billing practices in the hospital sector, indicating a federal push toward these reforms starting in the spring.
However, voices of opposition, such as Federation of American Hospitals President Chip Kahn, cautioned against the bill, expressing concerns that site-neutral provisions could limit patient access to hospital care in rural areas. Kahn underscored the financial disparity hospitals face, being paid less by Medicare while requiring additional funding due to their continuous operation and stringent safety standards.
Despite opposition, the American Hospital Association echoed similar sentiments while expressing additional desires for the legislation, including provisions regarding price estimator tools, penalties for noncompliant hospitals, and reporting requirements for 340B entities.
The bill encountered a delay in September amidst political turmoil in the House but might resurface for a vote. The impending vote, requiring a two-thirds majority due to its placement on the suspension of rules calendar, anticipates some bipartisan support from Democrats, but uncertainty remains regarding unanimous support from Republicans, as reported by Axios.
The House Energy and Commerce Committee marked a significant milestone by advancing 44 healthcare bills, notably targeting PBMs. These bills aim to address concerns about PBM practices, with specific acts like the Protecting Patients Against PBM Abuses Act and the Medicare PBM Accountability Act. Additionally, there is a proposal to reverse the 2024 physician pay cut, drawing criticism from the American Medical Association following a decision by the Biden Administration.
Amidst these developments, Steven Anderson, CEO of the National Association of Chain Drug Stores (NACDS), commended the efforts to reform PBMs, urging Congress to capitalize on this bipartisan momentum and prevent PBMs from obstructing the legislative process.
While the NCPA expressed concerns about changes made to pharmacy provisions, they remain hopeful that lawmakers will rectify disparities between vertically integrated PBM-affiliated pharmacies and independent pharmacies.
The Lower Costs, More Transparency Act signifies a pivotal juncture in healthcare legislation, encapsulating efforts to address pricing transparency and access concerns. While lauded for its bipartisan initiative and strides toward fairer healthcare practices, the Act faces opposition over potential limitations to patient access and funding disparities for hospitals. Uncertainty looms over its immediate impact, compounded by political nuances and varying stakeholder opinions. Nevertheless, the Act’s potential to reform pricing structures, extend federal programs, and foster transparency hints at a transformative potential, albeit within a landscape fraught with complexities and diverse perspectives in the quest for equitable healthcare.