Last week, the Senate HELP Committee held a hearing on a bipartisan cost containment package, dubbed the Alexander-Murray bill. The draft, shared prior to the hearing, represented months of deliberation about health care costs – including invited comments from health economists, advocates and other stakeholders. Senators Alexander and Murray used the hearing to lift up the core drivers of high health care spending and to develop a narrative about consensus regarding pathways to contain costs over the short and long run. The mark-up of the legislation is currently underway and we anticipate limited changes. The cost containment package offers a small cracked window into what bipartisan work can achieve – and, significantly, the bill draft provides a glimmer of hope for health justice by squarely addressing structural racism as a core driver of health disparities. This is an important and modest step forward in advancing health equity.
The bill itself is divided into five parts – encapsulating key themes or leading issues for Congress this session: surprise out-of-network billing, high cost of prescription drugs, data sharing and transparency, maternal health and all-payer claims database. The proposed bill also serves as vehicle to extend funding for community health centers (CHCs) for five years. There is a lot packed into the bill – and a lot of “good stuff” to feel positive about. Below are some key pieces we are monitoring.
Surprise Out-of-Network Billing
The section that addresses surprise out-of-network billing deserves its own blog (forthcoming). This is an issue that we’ve discussed at length as a top concern for consumers – but also as a key piece of cost containment. See here. In sum, the package moves negotiations forward on a main sticking point – payment settlement between provider and issuer. Stay tuned for more on this topic.
The bill also addresses the high price of drugs – another core consumer issue and very real financial and well-being concern for households, particularly for older people, people with chronic illnesses and people with disabilities that rely on medication to maintain and extend their lives. While the solutions proposed by the Alexander-Murray bill are not adequate to address the problem of excessive drug prices, they are a positive step in the right direction. Again, Community Catalyst has offered a set of comprehensive policy solutions at both the state and federal levels to address the rising prices of prescription drugs.
Health Disparities and Structural Racism
The fourth section of the bill draft is dedicated to public health with a focus on maternal and infant health. Health disparities based on race are especially acute in this area; Black women die from childbirth-related complications at a rate three to four times higher than white women, while Black infants are 2.4 times more likely to die than white infants. Embedded within the section on public health, there are provisions that specifically address structural racism and provider bias. Without glossing over the important sections that include a campaign to increase awareness and take-up of childhood vaccination, an effort to disseminate evidenced-based best practices for obesity prevention and grants to states for public health data system modernization – the most exciting section for health justice advocates are those dedicated to maternal health. Key sections include:
- Efforts to address discrimination in caregiving across the pregnancy care continuum (innovation in maternal health to reduce discrimination; training for health professionals that includes implicit bias training; and evaluation of provider trainings). Grants offered to a range of training entities.
- Perinatal quality learning collaborative to improve health outcomes for women and their infants. Grants provided to states to support or establish learning spaces for practitioners to improve maternal and infant health outcomes.
- Promotion of integrated services for pregnant and postpartum women. Grants directed at expanding integrated services that address issues that contribute to adverse maternal health outcomes, pregnancy-related deaths, and related health disparities, including disparities associated with racial and ethnic minority populations.
These sections provide multiple opportunities for states, tribal entities and health professionals to work collaboratively to improve maternal and infant health. Grant recipients and collaborators include states, tribal entities, health professional training programs, academic institutions and community based organizations—recognizing the broad set of stakeholders and programmatic components necessary to address the public health crisis of maternal death that disproportionately affects black women. Notably, there is a section devoted to provider training that explicitly includes implicit bias in the context of maternal care across the prenatal, pregnancy and postpartum continuum.
The sky feels oppressively gray this summer as we work to protect consumers from attacks on their health care ranging from the Trump Administration’s effort to full invalidate the ACA via the Texas v. U.S. case to the multiple attacks on immigrant, LGBTQ+ and low-income people through rule-making and administrative sabotage. The bipartisan cost containment package offers a glimmer of hope that Congress can move good ideas and that addressing structural racism is a non-partisan issue that can be acknowledged and addressed through bipartisan action. We applaud the authors of the package and as advocates, we will continue to demand that these issues are at the center of our work to improve health care access and quality. State and community level partners can join in by reminding their elected members over July recess that this is what good governance looks like. And we want more of it.