In the past few months, you may have seen the news coverage and commercials about this controversial new bill. The bill titled: 1985, Lower Health Care Costs Act aims to make key changes that will impact the healthcare industry.
This bill has been fiercely debated because of how radical some of these changes are.
So to help keep you informed, I’ve reviewed the America Health Insurance Plans (AHIP) summary of 1985 and outlined some of the major changes this bill will have on patients and the health care industry.
If you would like a full copy of the AHIP summary, click here to download the pdf.
To begin, let’s look at the 5 major sections of the bill:
Title I- Surprise Medical Bills: Basically, this section would like to do away with being billed for out of network providers during an emergency and having your bill be totally outrageous and not the customary cost of that service. Also in this section, if a patient happens to go to an in-network facility for an emergency but receive services from an out of network doctor the patient will be held harmless.
This bill would also hold patients harmless for surprise air ambulance bills. No one plans on getting airlifted and it assumes that if you are getting airlifted you probably will not have time to make sure that the air ambulance is in-network.
Title II – Prescription Drug Prices: This section’s goal is to allow generic drugs to get to the market quicker by removing the roadblocks that manufacturers face in getting drugs to consumers.
In addition, this section of the bill would stop manufacturers from gaining a 5-year new chemical entity (NCE) exclusivity when they “tweak” the chemical properties of a previously created drug. This is important because NCE exclusivity prevents manufacturers from being able to provide consumers generic versions of a drug quickly. Now NCE exclusivity will only be granted to newer, innovative or novel drugs.
Also, this section now allows generic drug manufacturers to sue brand name manufactures for not selling them samples for testing.
Title III – Transparency in Health Care: Title III is HUGE and positively impacts all patients. If you’ve ever had trouble finding out the true cost of a medical procedure, this section aims to provide some assistance.
- Title III removes something called “The Gag Clauses” which prevents the health plans enrollees, plan sponsors, or referring providers from seeing cost and quality data on providers.
- Also, it prevents “anti-tiering”, “anti-steering” and “all or nothing” clauses between providers and health plans that require health insurance plans to contract with ALL providers in a particular system/network or NONE at all.
- Requires health plans to have up to date directories of their in-network providers which shall be available to patients online.
- It requires healthcare facilities to provide patients with a list of services and a bill within 5 calendar days after discharge and all adjudicated bills to be furnished to the patient within 45 days. If bills are received more than 45 days after receiving care, the patient is not obligated to pay. This gives patients at least 35 days after postmark to pay the bill.
- Lastly, it requires health insurance brokers to disclose what compensation we receive by providing service to the consumers.
Title IV – Public Health Initiatives: This section improves the national campaign efforts to increase awareness and knowledge on the safety and effectiveness of vaccines for the prevention and control of diseases.
It also requires states to apply for federal youth suicide early intervention and prevention grants.
In addition, it raises the National tobacco purchasing age from 18 to 21.
Title V – Exchange of Health Care Information: Lastly, this section’s focus is on improving the Exchange of Health Information making it easier to figure out in-network providers and out of network providers.
Although most of the 1985: Lower Health Care Cost Act will not take effect until 18 months after it passes, it will be important to stay informed.
As you can see, this bill will have some immediate impact on the way the health care industry does business and the rights patients have.
For further info: AHIP has prepared a section-by-section summary of the “Lower Health Care Costs Act” (S. 1895). This bipartisan bill was approved on June 26, 2019 by the Senate HELP Committee by a vote of 20 to 3. It includes proposals addressing: (1) surprise medical billing; (2) prescription drug prices; (3) transparency in health care; (4) public health initiatives; and (5) the exchange of health information.