GOP’s new healthcare bill targets hospital costs and consolidation


New 200-page healthcare proposal by GOP House lawmaker goes after hospital consolidation and pricing as part of a broad attempt to cut costs and increase coverage.

The legislation of Representative Bruce Westerman (R-Ark.), Who has worked there for over a year and a half even though he does not sit on any House health committee, signals growing unrest among individual members of the Congress. on the high costs of health care. This feeds the momentum on both sides to remedy the debt consolidation of hospitals.

“If you’re concerned about monopolies in general, I think there are people left and right who share that concern,” said Avik Roy, a Tory political adviser who consulted on Westerman’s bill. .

The Westerman hospital arrangements would, among other things, increase the resources of the Federal Trade Commission to prosecute mergers, reward states that repealed their certificates of need, scope of practice, and consenting supplier laws, and reduce rates of mergers. health insurance for hospitals in concentrated markets

They reflect proposals by representative Jim Banks (R-Ind.) – co-sponsored by Westerman – which would crack down on consolidation and mergers. Leading Democrats on the House Judiciary Committee, Representatives Jerrold Nadler (DN.Y.) and David Cicilline (DR.I.), are also interested in antitrust issues in healthcare.

Roy said anti-tax Republicans must step up efforts to meet costs, especially now that the median share of family health care costs is 15% of their income, more than their new tax rate. .

“Tax rates are low, but hospital and health spending is a component of family spending, and if we allow monopoly power to extract high prices, you get to the point where it’s a tax more. significant to a family than the actual tax collected by the Internal Revenue. Service, “Roy said.” If we’re not at a tipping point now, we’re getting close to it. ”

Inclusion of the hospital provisions in a bill that also addresses the Affordable Care Act and prescription drug market exchanges, as well as Medicaid and Medicare, reduces Westerman’s goal of bipartisan support to tackle to the problem of costs.

It is not clear where the legislation will go next. Westerman is a grassroots member and does not sit on the Energy and Trade or Ways and Means committees. Yet he has been working on the legislation since the effort to repeal and replace the GOP collapsed in 2017.

This is the first major healthcare proposal from a Republican since that failure, and comes as the progressive wing of Democrats sees an opening for a single payer or Medicare for All. Some GOP lawmakers have grown eager to come up with something of their own on healthcare, especially after bruising losses in 2018.

Westerman staff have engaged in constant back and forth with the Congressional Budget Office on individual elements of the bill to ensure that they balance the issues of cost and coverage.

“Going back to the early days, when I did a post mortem analysis of US healthcare law, I think what hurt him politically was the Congressional Budget Office score,” he said. said Westerman. “When we first discussed it, I said, ‘We need to have a bill that covers more people and cuts costs. “If it covers more people, who can dispute that? If it’s cheaper, who can dispute that?”

In addition to the provisions relating to hospitals, the bill includes the bipartite principle Create the act Senator Patrick Leahy (D-Vt.) to promote competition for generics and biosimilars in the drug market; it would create a federal reinsurance pool of $ 20 billion per year; and that would fuel major anti-monopoly efforts against hospitals.

ACA market-related provisions include a change in the rating range from a 3-to-1 spending cap ratio for seniors to 5-to-1 – proposed in the GOP’s U.S. Healthcare Act – a repeal of the employer’s mandate, and “copper” and 12 months short term plan option.

The bill would also allow cost-share reduction payments and shift federal employees into exchanges – a move, according to Westerman’s office estimates, could nearly double the existing forex market.

Additionally, it would loosen Stark and anti-recoil laws for hospitals – currently the goal of a regulatory push in HHS– and extend Medicare reimbursement for telehealth. It would tighten hospital reporting requirements for the 340B drug rebate program, as well as for drug benefit managers.

Westerman’s big Medicaid and Medicare overhaul proposals are unlikely to bring Democrats on board. Under the bill, Medicaid could offer a state the option of block grants for the traditional population and shift the rest to exchanges – a move that could be expensive under the status quo of the individual market.

In addition, while people with more than $ 10 million in their lifetime declaring salary income could retain traditional health insurance (Part A), they would lose their eligibility for Parts B and D as well as Medigap.

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