Speeches & Floor Statements

Health Care Costs Floor Speech

Posted on July 30, 2019

I often recommend that you look at the United States Congress as if it were a split screen television set.

Here’s what I mean by that.

During the last month, on one side of the screen you saw the usual turmoil: Trump vs. The Squad, Mueller testifying, impeachment votes, battles over the border, presidential candidates posturing, and of course the daily tweets.

On the other side of the screen there was the President and congressional leaders agreeing to a two-year budget that will strengthen our military and help our veterans, fund research for medical miracles and national laboratories and national parks, and save taxpayers a boatload of money by providing stability in funding.

And then, also on that side of the screen, there was another story, which is what I want to talk about today.

During that same month, three Senate committees reported, by my count, more than 80 bipartisan proposals sponsored by at least 75 senators to reduce the cost of the health care that Americans pay for out of their own pockets.

On June 26, after 17 hearings, six months of work, and recommendations from over 400 experts, our health committee, which I chair and which Senator Murray is the ranking member, voted 20-3 to recommend to the full Senate 55 proposals from 65 senators that would end surprise medical billing; increase transparency so you can know the cost of your medical care – you can’t lower your health care costs if you don’t know what your health care costs; and increase competition to reduce the cost of prescription drugs.

The next day the Judiciary Committee reported out four proposals from 19 senators that would reduce prescription drug costs by banning anticompetitive behaviors by drug manufacturers and helping the Federal Trade Commission block those who game the citizen petition process to delay generic drugs and biosimiliars.    

And then last Thursday, the Finance Committee, by a vote of 19-9, reported more than two dozen bipartisan proposals also aimed at reducing the cost of prescription drugs.

That is not all.  

The House Energy and Commerce Committee has passed its own solution to end surprise billing.

Last Thursday, Senator Murray’s staff and I met with Representatives Frank Pallone and Greg Walden, the leaders of the House Energy and Commerce Committee.  

The four of us agreed to work together to lower health care costs.

All of this work is consistent with what Secretary Azar and the President have been saying and doing to lower prescription drug costs and increase transparency.  

Last week, after the Finance Committee released its legislation, the White House said it “is encouraged by the bipartisan work of Chairman Grassley and Senator Wyden to craft a comprehensive package to lower outrageously high drug prices, and today we are engaging with coalitions to help build support.”

Here is why this amount of activity on so many fronts is such a good sign.

In our committee, what we have seen before with Fixing No Child Left Behind and the 21st Century Cures Act and last year’s response to the opioid crisis – the last of which occurred, by the way, when on the other side of the split screen TV there was the acrimonious Kavanaugh hearing—what we have seen with these recent new laws is that when so many senators and congressmen are working on an important objective in a way that its consistent with the president’s objective, that there is likely to be a result that benefits the American people.

In other words, legislation to end surprise medical bills, increase transparency, and lower prescription drug costs is looking look like a train that will get to the station when Congress reconvenes in September.

And it well should. 

The cost of health care is Americans’ number one financial concern, according to Gallup.

And at one hearing before our health committee, experts from the National Academy of Medicine testified—that up to half of what our country spends on health care is unnecessary. 

This is such a startling fact that I sat down with Senator Murray and Senators Grassley and Wyden, the leaders of the Finance Committee, and I talked with Senators Graham and Feinstein, the leaders of the Judiciary Committee, and said, surely Democrats and Republicans can find SOME things we agree on about how to reduce what Americans pay for out of their own pockets for health care.

The work of these three committees, more than 80 proposals from at least 75 senators, is the result of that work over the last six months.

Let me say a word about perhaps the most visible proposal in the health committee’s bill.

Surprise medical billing is one of the most urgent problems that the House, the Senate, and the president are trying to fix.

After 20 percent of emergency room visits, patients are surprised a few months later to receive an unexpected bill that may be $300 or $3000.

This happens because patients see a doctor they did not choose: either because of emergency care at an out-of-network hospital, or because an out-of-network doctor, not chosen by the patient, treats them at an in-network hospital.

In his State of the Union address, and again at a White House event in May, President Trump called for an end to surprise billing.

At the event, he gave me a copy of this medical bill.  

It was a bill sent to Liz Moreno a Texas college student, who had had back surgery and during a post-surgery follow up visit, her doctor ordered a urine test. 

A year later this bill showed up -- $17,850 for that urine test.

That’s about the price of a new Nissan Sentra.

The bill was sky high because the lab that ran the test – a lab Liz had no way of choosing – was considered out-of-network with her insurer.

Drew Calver, from Texas, also told the President his story of getting $110,000 in bills – both the emergency room he was rushed to – during his heart attack – was out-of-network and so were the doctors who treated him

That day, President Trump said, “For too long, surprise billings . . . have left some patients with thousands of dollars of unexpected and unjustified charges. . . . So this must end.”

The Lower Health Care Costs Act that the Senate health committee passed last month – by a vote of 20-3 – would have protected Liz and Drew from receiving those surprise bills.

Here’s how it works: insurance companies would pay out-of-network doctors a local, market-driven “benchmark” rate — which would be the same local market-based rate that insurers negotiated with doctors who agreed to be in-network.

Obviously this saves Liz and Drew money because they wouldn’t have gotten a surprise bill.

The Congressional Budget Office says, by ending surprise medical billing, this approach would lower health insurance premiums.

And CBO estimates this approach would save taxpayers $25 billion over the next ten years.

Based on data from Kaiser, only about five percent of doctors at ten percent of hospitals send most of the surprise bills.

So our solution primarily effects doctors patients have little control over choosing: anesthesiologists, radiologists, pathologists, emergency room doctors, and neonatologists.

It does not affect doctors that a patient can choose, like cardiologists, or primary care doctors or pediatricians.

In fact, the American Academy of Family Physicians, representing primary care doctors, support the Lower Health Care Costs Act.

Over the 17 hearings the health committee conducted in developing our legislation to lower health care costs, we heard many stories about surprise billing.

Here is one: Todd is a Knoxville father who recently took his son to an emergency room after a bicycle accident.

Todd was surprised when he received a bill for $1800 – because even though the emergency room was “in-network,” the doctor who treated his son was not.

Ahead of the birth of their first child, Danny and his wife Linda, from Georgia, choose an in-network doctor and hospital.

But when Luke was born three weeks premature, he had to spend 11 days at the in-network hospital’s NICU.

In the weeks after Luke went home, $4,279 in bills were sent to Danny and Linda because the NICU, located in their in-network hospital, was out-of-network.

Carrie Wallinger, from Phoenix, Arizona, received a $9,000 surprise medical bill after going to an in-network emergency room after her dog bit her finger -- the doctor who came to stich up her finger was from an out-of-network facility.

A South Carolina woman who had to have an emergency C-section received  a $15,000 bill for the out-of-network anesthesiologist.

Lisa Ricks, from Louisiana, went to an in-network emergency room after accidentally stabbing herself in the eye with a metal broom handle.

Nine months later, she received a $585 bill from an out-of-network doctor who treated her at the in-network hospital. 

In Texas, after an ATV crushed his arm, Dr. Naveed Khan, a radiologist, needed advanced emergency medical care. The cost of a 108-mile trip in an out-of-network helicopter? $44,631.

Nicole Briggs, from Colorado, had emergency surgery to remove her appendix at an in-network hospital. She owed $4,727 because the surgeon was out-of-network.

In Mississippi, Stacy White took her husband to the Emergency Room at an in-network hospital. The emergency physician who saw her husband was out of network, and they received a bill for $2,700.

West Coz, a three-year old with a 107-degree fever, was airlifted from a small community hospital in West Virginia to a more advanced hospital 75 miles away. His parents were left with a $45,930 bill for the helicopter.

In Maine, the State Representative who sponsored a bill to protect patients against surprise bills, received a several hundred dollar bill after the radiologist who read his daughter’s X-ray was out-of-network – even though he took his daughter  to an in-network hospital.

There are more stories I could tell, but the bottom line is that each case happened because the patient almost always had little choice.

And if you don’t have choice then you don’t have a functioning market – it is a market failure. One reason for the uptick in surprise bills is that this market failure is now being exploited by private equity firms.

Often times, hospitals will contract with a company to staff their emergency rooms and hospitals.

These companies will handle billing, managing schedules, and hiring doctors to staff the hospital emergency room.  

Research done by Yale economist Zach Cooper found that two of the leading staffing companies – both backed by private equity firms --  significantly increase the rate of out-of-network billing in a hospital once the firms are hired.

In the case of one of the physician staffing companies Cooper studied, a large insurer’s data showed that the cases of surprise billing increased by 100 percent at six different hospitals once this physician staffing firm took over those hospitals’ emergency rooms.

In a New York Times article, Cooper described the 100 percent jump in surprise bills once these private equity-backed staffing companies entered by saying it was “almost…like a light switch was being flipped on.”

And in Axios, Cooper said, “If you’re willing to engage in some fairly unsavory billing practices, (these services) could be quite lucrative…that’s just discouraging, and it makes people want to go to single payer.”

Our goal is to protect patients – not the private equity firms and companies who are taking advantage of patients.

Surprise medical bills are one of the most visible problems for the 180 million Americans who get their health insurance on the job.

When growing numbers of patients are receiving surprise medical bills that could bankrupt their families it is time for Congress to act. 

If Congress cannot fix such an obvious market failure in health care, pressure will only grow for a radical federal takeover of health care that will take away private insurance from the 180 million Americans who get insurance on the job, and leave patients with less choice, fewer doctors, and worse health care.

Avik Roy has written in Forbes that “if we do nothing [to address surprise medical bills], the problem will get far worse. If we do something that is too incremental, we’ll pat ourselves on the back and then be forced to revisit the problem in a few years. Americans deserve market-based alternatives to single-payer health care. Without reform of exploitative hospital prices, we’ll never get there.”

Americans want to be mindful consumers of health care.

When Todd, the Knoxville father, wrote me he said, “If I’m expected to be a conscientious consumer of my own health care needs, I need a little more help.”

It is unacceptable to say to patients that, even by paying their premiums every month, even by researching and choosing in-network doctors and hospitals, they may be on the hook for thousands of dollars because of a surprise bill that they had no control over.

At least 75 senators and the president have made it clear that our intent is to end surprise billing and to reduce what Americans pay out of pocket for their health care.

When Congress reconvenes in September, I would encourage all of my colleagues to support these efforts to reduce health care costs.

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