The Senate health committee chair on Monday amended its suite of healthcare proposals to include the Creates Act, aimed at boosting the generic-drug market, and to raise the legal age for buying tobacco products to 21.
These two major additions to the package from committee leaders Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) didn't come as a big surprise. The Creates Act cleared the Senate Judiciary Committee last year, and two committees in the U.S. House of Representatives, but has not been up for a floor vote yet. The bill would prohibit brand-name manufacturers from keeping drug samples out of the hands of generic competitors.
The proposal to raise the legal age for purchasing tobacco was first introduced at the end of May by Senate Majority Leader Mitch McConnell (R-Ky.) and Sen. Tim Kaine (D-Va.). A stated priority for McConnell, the bill would target vaping devices and e-cigarettes as well as cigarettes, amid mounting public health concern about widespread teen use.
Still, this amended version of the healthcare package, known as the "manager's mark," ignores hospitals' increasing opposition to proposed contract reforms and the proposed rate cap for out-of-network charges through the committee provision to ban surprise medical bills. Those provisions represent a core part of the legislation's aim to cut excessive costs out of the healthcare system.
In one tweak to the provision that bans balance billing, not all out-of-network care at an in-network facility would be subject to the benchmark. As long as it isn't ancillary or emergency treatment, a patient would have to pay the out-of-network charges once certain protections are met — including a 48-hour notice of what the charges would be and signed approval. Patient advocates want the committee to require patients in this situation to have at least an in-network option.
At this point it isn't clear whether the committee would approve any additional major changes.
The contract reforms are backed by major employer groups and some of the practices targeted by the legislation have spurred high-profile lawsuits in California and North Carolina.
The formal introduction of the Alexander and Murray legislation last week drew a letter from American Hospital Association Executive Vice President Tom Nickels. In the letter, Nickels once again asked the committee to remove the proposed regulation of certain hospital contracting practices as he had after the committee first unveiled its discussion draft.
"We are disappointed that the contracting provisions remain in the Lower Health Care Costs Act, as we believe these restrictions could lead to even more narrow networks with fewer provider choices for patients, while adversely affecting access to care at rural and community hospitals serving vulnerable communities," Nickels wrote. "We continue to urge the committee to remove these provisions from" the bill.
More amendments are likely coming. Senators have until Tuesday morning to file any additional proposals ahead of the Wednesday morning committee markup and vote. Alexander is eyeing a July Senate floor vote for his legislation, which he hopes to pair with the upcoming proposals on drug pricing from the Senate Finance Committee.