Bill Information
The Lower Healthcare Costs Act of 2019 is a bipartisan healthcare bill introduced by Lamar Alexander, Tennessee senior senator of the Republican Party, in June 2019. The bill seeks to resolve some of the major issues associated with healthcare out-of-pocket payments and potentially create a degree of consensus between the Democratic and the Republican party (“S. 1895,” 2019). The bill goes under the number of S. 1895 and is estimated to have high chances of passing both the House and the Senate legislative deliberations. Its main purpose is to reduce patient spending by having the government and healthcare institutions shoulder some of the expenses. The total length of the bill is at 444 pages, making it a significant legislative endeavor on the part of its sponsors.
Bill Summary
The section-by-section summary of the Lower Health Care Costs Act highlights the important points emphasized on in the bill. Its primary goal is to establish a framework of relations between plans and out-of-network providers, with customer benefit in mind (“S. 1895,” 2019). In addition, it prevents companies to add follow-up expenses without prior and expansive consultation with the customer, thus seeking to end the unsavory practice of expanding the budget without the patient’s knowing by adding extra services and forcing individuals to pay for them post-factum. The reduction of prescription drug prices is another major point of the bill, as it seeks to ensure that all the necessary prescriptions drugs receive a sizeable discount. All these measures, together, should increase the efficiency and transparency of the public healthcare system.
Implications for Nursing Standards if Passed
S. 1895 Lower Health Care Costs Act has great positive implications for nursing standards, should it pass. Its primary aim is to increase the levels of transparency between patients and nurses, since surprise bills are to be eliminated as a whole, instead replaced by pre-emptive interactions to determine if the patient desires/is capable of paying for the additional support required (AHA, 2019). This will give the patient a greater degree of control and autonomy over their own healthcare process, thus increasing the degree of involvement, as per the tenets of patient-centered care. Lastly, the bill is likely to eliminate the corrupt practice of purposefully adding needless treatments in order to expand the patient’s paying bill, thus saving time, effort, and equipment for nurses to use in more pressing matters.
Implications for Nursing Standards if Not Passed
Should S. 1895 Lower Health Care Costs Act fail, the system would remain functioning as it is now. The problem of surprise medical bills will remain unresolved, and uninsured patients receiving services from out-of-network physicians will remain vulnerable to surprise bills that exceed the patient’s desire and capacity to pay (AHA, 2019). This is associated with greater expenses, the lowering of standards of practice, and increased workloads performing what seems to be unnecessary and useless work. Patient involvement will remain low, as it is right now, since in the majority of the cases they will not be aware of the necessity or options available to them. The chance to improve nursing standards will be lost.
Impact of the Bill on My Nursing Practice
In regards to my own patient practice, the bill offers significant opportunities for my own nursing practice. The most important feature of the bill includes price reductions on prescription drugs. It would give me an opportunity to recommend better and more appropriate medications to poor patients that would have been unable to afford it otherwise. The quality of care would improve as a result. In addition, I would be less worried about cooperating with out-of-network specialists, as I would not need to rely on personal experiences with them in order to ensure their trustworthiness towards the patient (HELP, 2019). Overall, the bill promises quick short-term improvements to my nursing practice. Future state-wide budgeting issues will be addressed in the next session of this presentation.
Concerns for the Bill
The primary issue I have with the bill is its reliance on benchmark rate payments, which have been notorious failures in other industries in the past, such as the Airline Deregulation Bill of 1979 (Shulman et al., 2019). The imposition of government-dictated reimbursement programs, should it succeed in its primary function, would have significant unintended consequences for patients, as insurers are likely to increase costs and break contracts with their provider networks, and the out-of-network physicians are likely to increase the prices for their services, given that the government will reimburse them anyway (AHA, 2019). In addition, the bill will simply not work on some business models that rely on surprise bills, such as air ambulances.
Communicating Support and Concern
As it was stated in previous slides, the S. 1895 Lower Health Care Costs Act has some strong points and some areas there should be additional deliberation on. Prescription drug price reduction and the increase of patient transparency are its strong points, as high prices and a lack of patient participation have been affecting the nursing community for a while now. However, the benchmark rate payment system may cause an overall increase in prices as well as various other problems further down the line. A nurse can communicate its support and concern in several ways, by writing letters to their respective senators, the senators that either support or oppose the Bill, and working together with ANA and other nursing associations to lend political power to their position.
Proposed Amendment to the Bill
Instead of relying on the benchmark payment system that would encourage a gradual increase in prices, I propose that the ability of any medical provider to issue and collect charges should be removed altogether (Schulman et al., 2019). That way, instead of being forced to pay inflated prices in the absence of a negotiated contract (which often happens in ambulance services), providers will be entitled only to the prevailing market prices for their services. That way, surprise bills are less likely to become a problem in services where patient negotiation and consent are limited, while forcing full disclosure of all market prices by healthcare managers.
Impact on the Community
The effect on my community will likely be ambivalent. The initial gains from lower prices on prescribed drugs will be felt almost immediately, as poor patients will be able to benefit from it. Since the majority of individuals and families in my community have basic insurance, individuals without one would likely gain more from the Bill than other people would, as it impacts out-of-pocket payments the most. At the same time, the cooperation between different networks is likely to improve. At the same time, the relationship between out-of-system practitioners and the insurers will be undermined, since the latter won’t be required to maintain a trusted network of specialists anymore. This would result in price increase for both the insurers and providers alike.
Conclusions
Despite the bill’s initial shortcomings, evidence shows that S. 1895 Lower Health Care Costs Act will bring significant improvements to the imperfect system we have in place nowadays. The most significant points include the reduction of prescription drug prices and increased transparency between patients. Although the reimbursement system may cause unintended side-effects, recent news shows that the legislators have been made aware of the problem through the efforts of ANA and AHA, meaning that some fail-safes are likely to be introduced before the bill is passed on to the Senate and House evaluation. S. 1895 Lower Health Care Costs Act has the potential to become a benchmark document of modern American healthcare.
References
American Hospital Association (AHA). (2019). Senate HELP leaders introduce Lower Health Care Costs Act. Web.
Health, Education, Labor & Pensions (HELP). (2019). Senate health committee leaders introduce bipartisan legislation to reduce health care costs. Web.
S. 1895: Lower Health Care Costs Act. (2019). Web.
Schulman, K. A., Milstein, A., & Richman, B. D. (2019). Resolving surprise medical bills. Web.