Studying the Affects Pricing Medical Procedures Based on Patient Need, Not Cost (H.R. 2570)

What is H.R. 2570?

(Updated September 21, 2018)

This bill seeks to increase access to medical facilities by studying how lower co-payments for people on Medicare impacts how often they go to the doctor, and general "clinical outcomes." 

Two years after the bill is passed, a three year program would be initiated to study “value-based insurance design.” This model essentially sets the price for treatments and prescriptions based on how important they are to the patient —  how much they cost the hospital. The program would be rolled out at two Medicare facilities chosen by the Secretary of Health and Human Services (HHS).

Patrons of the facility would, of course, have to be notified that the study was underway. The facility would also have the power to choose which treatments and prescriptions would have their prices reduced for the study. The study gives these facilities permission to do away with copayments, but they can’t raise them.

One year after completing the study, the HHS would have to submit a report to Congress. The program would also be reviewed by an independent agency.

Argument in favor

This bill opens the door for exploring ways to ensure that everyone can get the treatment that they need — no matter the price. No one should be denied care because they can’t afford it, nor should they be saddled which medical bills.

Argument opposed

There’s a reason some treatment costs a lot of money: it costs the hospitals a lot of money. They’re not profit-crazed money machines — they’re often just trying to stay afloat.

Impact

Medicare recipients, especially those at the chosen facilities, facilities in the study and their staff, health care policymakers, and the Department of Health and Human Services.

Cost of H.R. 2570

A CBO cost estimate is unavailable.

Additional Info

Of Note: The Affordable Care Act now requires some medical treatments be given without copayment. It also allowed the HHS to begin setting up guidelines for value-based insurance design. 

They’re still working on it, but others have begun to make use of them. Oregon’s public employees use a value-based system, and at least one study has found it effective. But raising the price for some treatments — which this bill doesn’t allow — might be a necessary part of the equation. The insurance board had to raise prices for some procedures after finding that they were overused.

In Depth: Sponsoring Rep. Diane Black released a version of this bill in 2014. That bill, like this one, has bipartisan support.