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Pennsylvania House of Representatives
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=H&SPick=20170&cosponId=24730
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House of Representatives
Session of 2017 - 2018 Regular Session

MEMORANDUM

Posted: October 16, 2017 04:27 PM
From: Representative Jim Christiana
To: All House members
Subject: Reforms to Address Restricted Health Care Income
 
Ever-increasing healthcare spending is impacting local government, businesses, and individual consumers by crowding out the possibility for other spending – on education, businesses expansion, or household budget items. According to some estimates, health care spending will be 20 percent of our gross domestic product by 2020. Hospital spending, a key driver of health care costs, has been growing at nearly 5 percent annually.

Hospital consolidation is one of the major components of this increased spending – experts link consolidation with increased rates and higher health care costs. Nonetheless, with the current changes in the marketplace further hospital consolidation is expected. Pennsylvania must get in front of this trend in order to create a fairer, more transparent healthcare system that encourages hospitals to compete based on value, rather than on market leverage. Patients should reap the benefits of clinical integration – better coordinated care and increased efficiency – but should be protected from the potential for collusion or other anti-competitive behavior leading to higher prices or restricted access.

Components of a fairer, more competitive healthcare marketplace include transparency, payment reform and real competition based on value. In the near future, we will be introducing legislation that begins to tackle some of these issues in order to ensure that consolidation does not result in higher prices and less access for our constituents to the hospital and doctor of their choice.

We propose to begin addressing marketplace fairness issues first by focusing on hospitals operating as part of an integrated delivery network – where a large health system and insurance carrier/health plan operate under the same corporate structure. These institutions deserve special attention, as they function both as providers and payers, and therefore can have an exceptional impact on the marketplace.

There are strong consumer protection and public policy reasons for adopting this legislation. These additional regulatory requirements accomplish two important objectives. First, by requiring hospitals and physicians operating as part of an integrated delivery network to contract with all insurers, consumers will not be denied care, or worse abandoned mid-treatment, simply because they hold one type of insurance over another. All consumers should be afforded access to these vital hospital and physician services, regardless of which insurance card they carry.

Second, the legislation will eliminate the ability of any dominant hospital system from demanding unreasonable rates for services from insurers, and in turn raising the overall cost of health care because they are the “must have” system in the area.

Please join me in co-sponsoring this legislation. If you have any questions, please do not hesitate to call my office at (717)-260-6144.



Document #1

Introduced as HB2127

Description: Requiring physician practices operating as part of an integrated delivery network to meet certain requirements to ensure patient access and consumer choice; and imposing powers and duties on the Insurance Department.
 

Document #2

Introduced as HB2128

Description: Amending the act of July 19, 1979 (P.L.130, No. 48), entitled "An act relating to health care; prescribing the powers and duties of the Department of Health; establishing and providing the powers and duties of the State Health Coordinating Council, health systems agencies and Health Care Policy Board in the Department of Health, and State Health Facility Hearing Board in the Department of Justice; providing for certification of need of health care providers and prescribing penalties;" in licensing of health care facilities, further providing for definitions, for licensure and for issuance of license; and, in general provisions, repeals and effective date, providing for confidentiality.