/ en Sat, 26 Apr 2025 03:55:35 -0500 Tue, 17 Oct 23 09:24:00 -0500 <h2><em><span>The Issue</span></em></h2> <p>The Bipartisan Primary Care and Health Workforce Expansion Act (S. 2840) includes a provision that would prevent doctors and hospitals from negotiating reasonable agreements with commercial health insurance plans. These contracting restrictions — known as tiering or steering — would allow insurers to make it more difficult for patients to choose their own doctors and hospitals by steering them to the providers the insurers own or favor. If passed into law, these provisions would limit patient’s choice and ability to seek care with their preferred providers and hospitals in their communities.</p> <p>This provision also would allow large commercial insurers to make financially-driven decisions about which hospitals in a network are under contract, enabling them to avoid hospitals serving vulnerable communities or those that serve sicker patients with serious or chronic conditions. The Congressional Budget Office has estimated that these provisions would save the federal government $1.1 billion over 10 years by limiting patients’ access to providers.</p> <h2><span><em>AHA Position</em></span></h2> <p><strong>The AHA opposes these contracting restrictions, which would lead to fewer choices for patients and further limit access to care, particularly for patients in urban, rural and other vulnerable communities. We urge Congress to abandon these provisions.</strong></p> <h2><span><em>Talking Points</em></span></h2> <ul> <li>Patients in underserved communities, including rural areas with high poverty rates, could lose access to care and health care coverage as insurers could cherry-pick the providers in a hospital network to avoid contracting with those in areas the insurer finds less financially desirable. <ul> <li>Because providing health care in rural areas is typically more costly than in other areas, an insurer could force rural patients to go elsewhere for services. Forcing patients to travel long distances for care will lead to delays or missed medical attention.<br />  </li> <li>These provisions would increase rural hospital closures. If insurers are allowed to prevent rural patients from receiving services in their communities, local providers will be unable to cover high fixed operating costs. The resulting financial strain will lead to less access to care and fewer coverage options as insurance plans would not cover the local doctors and hospitals in those rural and high poverty areas.<br />  </li> </ul> </li> <li>Congress should not force providers to agree to unfair tiering and/or steering restrictions, which would allow commercial insurers to further undermine providers’ efforts to coordinate high quality care. Commercial insurers cannot be allowed to profit from contracts premised on the provider’s capacity to serve its patients while simultaneously undermining them by encouraging patients to go elsewhere for care.<br />  </li> <li>These restrictions are unnecessary because studies show that the vast majority of health insurance marketplaces are highly concentrated. With commercial insurers already having such significant market power, they do not need Congress to grant them additional advantages through these contracting restrictions that will ultimately harm many patient’s access to quality care.</li> </ul> Tue, 17 Oct 2023 09:24:00 -0500 Products and Services Contracting