House vote amps up health cost transparency push
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The House just passed what could turn out to be its most substantial health care legislation before the elections. But hospital opposition to the package will cloud negotiations with the Senate after the Christmas break.
Driving the news: Lawmakers advanced a health price transparency bill affecting hospitals, insurers and pharmacy benefit managers in an unusually bipartisan 321-70 vote on Monday.
- It would require providers and PBMs to disclose more information about their business practices and delay billions of dollars in Medicaid cuts to safety-net hospitals.
But the sticking point is a proposal to prevent hospitals from billing Medicare at a higher rate than independent physicians for certain services.
- Such "site neutral" policies are gaining traction, spurred by allegations from insurers and employers that health systems are overcharging for services and not being transparent about their pricing.
Between the lines: Several prominent House lawmakers cited hospital opposition in voting against the transparency bill.
- Rep. Pete Aguilar (D-Calif.), a member of House Democratic leadership, broke with Minority Leader Hakeem Jeffries of New York and Minority Whip Katherine Clark of Massachusetts, who both supported the package.
- Aguilar cited concerns from "local hospitals" when Axios asked him after the vote why he opposed the measure.
- House Ways and Means ranking member Richard Neal (D-Mass.) also voted no and has pointed to concerns hospitals have raised about cuts to their payments.
Go deeper: The so-called site-neutral provision is modest, applying only to physician-administered drugs, but would reduce Medicare hospital payments by $3.7 billion over a decade, per the Congressional Budget Office.
- The Senate has been slower to consider site-neutral policies, but the big vote for the House package is seen as giving backers across the Capitol needed momentum.
What we're watching: Other provisions affecting provider payments and transparency requirements are riding on the outcome of the forthcoming House-Senate talks.
- The House bill would extend federal funding for community health centers through 2025 at $4.4 billion a year.
- The legislation also would strengthen Trump-era rules that require hospitals to disclose the rates they negotiate with insurers.
- And it would impose new transparency requirements on PBMs while banning "spread pricing" in Medicaid, where PBMs charge more than they pay for a drug and keep the difference.
A version of this story was published first on Axios Pro. Unlock more news like this by talking to our sales team.
