Tagged Health Industry

Surprise! Fixing Out-Of-Network Bills Means Someone Must Pay

President Donald Trump called on Republicans and Democrats to pass legislation this year to end surprise medical bills, in remarks made in the White House’s Roosevelt Room on Thursday. “We’re determined to end surprise medical billing for American patients,” Trump said.

Bills like those have been featured in the NPR-Kaiser Health News series launched in February 2018. Two patients whose medical bills were part of the series attended the event.

Austin, Texas, teacher Drew Calver talked about the six-figure bill he received after having a heart attack. “I felt like I was exploited at the most vulnerable time in my life,” he said. His bill was reduced to $332 after the NPR-KHN story was published.

A bipartisan group of senators has been working to come up with a plan for the past several months. They said Thursday that they hope to have a bill to the president by July.

But will bipartisanship be enough? Even political will might not overcome divisions within the health industry.

Specifically, lawmakers aim to address the often-exorbitant amounts patients are asked to pay out-of-pocket when they receive care at health facilities that are part of their insurance network but are treated by out-of-network practitioners. Legislators are also looking to address bills for emergency care at a facility that doesn’t have a contract with patients’ insurers.

“We’re getting really close to an approach that we’ll be able to unveil pretty soon,” Sen. Maggie Hassan (D-N.H.) told reporters on a conference call Thursday with Sen. Bill Cassidy (R-La.).

And it’s not just politicians and patients: Out-of-network doctors, insurance companies and hospital groups say they want the problem for consumers fixed, too.

Despite that broad agreement, a hurdle remains. Insurers and health care providers each oppose the other side’s preferred solution to end surprise bills. That conflict makes it almost impossible for lawmakers to come up with a fix that won’t leave one of the influential groups unhappy.

“It’s a different axis than the partisan [conflicts] we’re used to,” said Loren Adler, who has been studying the surprise-bill problem for the USC-Brookings Schaeffer Initiative for Health Policy. The fight over how to fix it is less likely “to break down between Republicans and Democrats and more likely to break down to where the money is” and which group will have to take less of it.

“I don’t see a coalescence around a solution,” said Chip Kahn, president and CEO of the Federation of American Hospitals, which represents for-profit facilities.

The divide is wide, despite the overall interest in protecting consumers.

“What we’d most like to see is clarity for the patients,” said Bob Kneeley, a senior vice president for Envision Healthcare, which employs physicians to staff a variety of hospital departments, such as emergency rooms, neonatal units and anesthesiology. “This is a system that’s just not working well for the patient, and we need to establish some appropriate guardrails.”

“We want this to be solved. We know it needs federal legislation,” agreed Molly Smith, a vice president at the American Hospital Association. She said hospitals believe that patients should “not have to be involved in any process if there’s a dispute between the payer and the provider.”

States have been working on the problem for several years. Nine now have programs aimed at protecting patients from surprise bills. But state laws cannot reach those with employer-provided insurance — more than half of all Americans — because those plans are regulated by a federal law called the Employee Retirement Income Security Act, or ERISA. That means only Congress can fix it for everyone.

Patients and groups that represent them say the problem is more urgent than ever.

“We are talking about situations in which families — despite enrolling in health insurance, paying premiums, doing their homework and trying to work within the system — are being left with completely unanticipated and sometimes financially devastating bills,” Frederick Isasi, executive director of the consumer group Families USA, told a House Education and Labor subcommittee hearing in April. “This is inexcusable behavior on the part of hospitals, doctors and insurers. They each know — or should know — that patients have no real way to understand the financial trap they have just walked into.”

Dr. Paul Davis, whose daughter received a bill for a $17,850 for a urine test after back surgery, also spoke at the White House on Thursday: “The situation is terrible. It is a national disgrace, and I think a lot of people would support me on that,” Davis told a reporter. Their story was the first featured in the “Bill of the Month” project.

Still, it’s not clear where compromise might be found.

By and large, doctors favor some sort of negotiated-fee system when there is a dispute about a bill, such as binding arbitration, in which an independent third party makes the ultimate payment decision.

“That’s consistent with what’s working in some states,” said Envision’s Kneeley.

Among those frequently cited by doctors’ groups is New York, which has one of the strongest state laws on surprise billing. There patients are not required to pay more than they would for an in-network doctor or hospital. For the remaining bill, an independent arbitrator settles any dispute between the provider and insurer.

But the insurance industry worries about that approach. “Our larger concern with arbitration is that it still relies on bill charges,” said Adam Beck, a vice president for America’s Health Insurance Plans, an insurance industry trade group. And insurers think those charges are too high.

A senior administration official also said on Thursday that the administration does not favor the arbitration approach, either.

Insurers — and many consumer groups — “believe if you have a clear benchmark pegged to reasonable rates, that will really solve this problem,” Beck said, because insurers would be more likely to cover charges they found more in line with what they consider reasonable.

A “benchmark” payment might correspond to what Medicare pays for the same service, for instance.

But doctors don’t like that idea one bit. “Even if [the benchmark] is on the high side, it’s still rate-setting,” said Kneeley.

Hospitals don’t like it, either.

“We can’t get behind any sort of rate-setting in statute,” said Smith of the AHA. “We have too many concerns about getting that wrong.” For example, she said, if the rate is set too low, hospitals might have trouble finding doctors willing to provide care.

Meanwhile, insurers and hospitals want to ban out-of-network providers from billing patients for whatever part of the charge the insurer won’t cover, a practice called “balance billing.”

Such bans are anathema to doctors, who instead believe insurers bear responsibility for doctors not being in their networks because they “don’t have an incentive to offer fair rates,” said Kneeley. Although insurers often feel they must contract with specific high-profile hospitals, he explained, the doctors who work there are often “invisible providers.”

Addressing the underlying causes of high health costs, however, will be difficult, said Adler of USC-Brookings.

Doctors want to be paid more than insurers typically offer, he said, which is why some do not join insurance networks. And insurers “want the problems [with surprise bills to patients] to go away.” The question for them, he said, is, “How much are insurers willing to pay to have their patients not get surprise bills?”

In the end, a settlement that eliminates surprise bills but builds the excess into everyone’s premiums doesn’t truly address health care’s spending problem.

“I think there’s a good chance it gets solved,” Adler said, and that lawmakers will eventually agree on a plan. “But I’m pessimistic it gets solved in a way” that deals with health care’s high costs.

KHN senior correspondent Fred Schulte contributed to this report. 

Podcast: KHN’s ‘What The Health?’ ‘Conscience’ Rules, Rx Prices and Still More Medicare


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In a new set of rules, the Trump administration wants to let not just doctors but almost any health care worker or organization decline to provide, participate in or refer patients for any health service that violates their conscience or religion.

Also this week, the Trump administration is ordering prescription drugmakers to include list prices in their television ads for nearly all products.

And there’s yet another entry in the growing group of bills aimed at overhauling the nation’s health system. This one is “Medicare for America.”

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Jen Haberkorn of the Los Angeles Times and Alice Miranda Ollstein of Politico.

Also, Rovner interviews Joan Biskupic, author of “The Chief: The Life and Turbulent Times of Chief Justice John Roberts.” Biskupic talks about the behind-the-scenes negotiations that led to the 2012 decision upholding the constitutionality of the Affordable Care Act.

Among the takeaways from this week’s podcast:

  • Robert Pear, who died this week, was the dean of health policy reporters and will be remembered not just for the many front-page stories he produced for The New York Times, but also as a generous and kind colleague who helped mentor many reporters new to the beat.
  • The Trump administration’s announcement last week of new regulations to protect health care workers from having to do anything they believe violates their religious beliefs is a stronger policy than past Republicans have adopted. But it follows other efforts to expand past conservative policies, such as the current administration’s more stringent Title X family planning rules.
  • The administration’s new rule requiring drugmakers to add list prices to their TV ads could confuse some consumers, since few of them actually pay that price. Their insurers often negotiate better prices, and other factors, such as geography and type of pharmacy, affect the consumer’s bottom line.
  • President Donald Trump this week told Health and Human Services officials to work with Florida on its plan to import drugs from Canada to take advantage of lower prices there. HHS Secretary Alex Azar said he would see if it can be done without jeopardizing the safety of the drugs. That is the rub that his predecessors have used to stop importation efforts, dating to the 1990s.
  • The increasing interest in Democratic proposals such as “Medicare for All,” which would set up a government-run health care system, and “Medicare for America,” which would offer a government-run option for consumers and businesses, suggests that a public option is not the political hot potato it was during the debate setting up the ACA. It’s also not clear whether consumers are ready to give up their current insurance.
  • Tennessee is getting ready to ask federal officials for a major change in its Medicaid system. The state wants to switch to a block grant, in which its federal funding would be limited but would come with much more flexibility for spending. The proposal is likely to end up in court because advocates for the poor argue the change would cut off services to some people and would violate laws that have defined Medicaid.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: CNBC’s “Insiders Describe Aggressive Growth Tactics at uBiome, the Health Start-Up Raided by the FBI Last Week,” by Christina Farr, and “Health Tech Start-Up uBiome Suspends Clinical Operations Following FBI Raid,” by Christina Farr and Angelica LaVito

Joanne Kenen: ProPublica and the New Yorker’s “The Birth-Tissue Profiteers,” by Caroline Chen

Jen Haberkorn: The Los Angeles Times’ “Health Insurance Deductibles Soar, Leaving Americans With Unaffordable Bills,” by Noam N. Levey

Alice Miranda Ollstein: Bloomberg News’ “Trump May Redefine Poverty, Cutting Americans From Welfare Rolls,” by Justin Sink

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Market Muscle: Study Uncovers Differences Between Medicare And Private Insurers

Private health insurance plans in 2017 paid more than twice what Medicare would have for those same health care services, says a sweeping new study from Rand Corp., a respected research organization.

Its study, which examines payment rates by private insurers in 25 states to 1,600 hospitals, shines light into a black box of the health industry: what hospitals and other medical providers charge. It is among the first studies to examine on such a wide level just how much more privately insured people pay for health care.

The finding: a whole lot. The difference varies dramatically across the country. And as national health expenses climb, this growing gap poses a serious challenge for lawmakers. The Rand data suggests a need for market changes, which could come in the form of changes in industry behavior or government regulation, in order to bring down hospital prices in the private sector. “If we want to reduce health care spending,” said Christopher Whaley, a Rand economist and one of the paper’s two authors, “we have to do something about higher hospital prices.”

Put another way, if, between 2015 and 2017, hospitals would have charged these health plans the same rates as Medicare, it would have reduced health spending by $7.7 billion.

The national discrepancy is staggering on its own. But the data fluctuated even more when examined on a state-by-state level.

In Indiana, private health plans paid on average more than three times what Medicare did. In Michigan, the most efficient of the states studied, the factor is closer to 1.5 — the result, the study authors said, of uniquely strong negotiating of the powerful UAW union, historically made up of autoworkers.

The difference between Medicare and private coverage rates matters substantially for the approximately 156 million Americans under age 65 who get insurance through work-sponsored health plans, researchers said. For them, higher hospital prices aren’t an abstraction. Those charges ultimately translate to individuals paying more for medical services or monthly premiums.

That’s especially true for the increasing number of people who are covered by “high-deductible” health plans and have to pay more of their health care costs out-of-pocket, said Paul Ginsburg, a health economist at the Brookings Institute. He was not associated with this study.

The gap between Medicare and private plans — and how it plays out across the country — underscores a key point in how American health care is priced. Often, it has little to do with what it costs hospitals or doctors to provide medical care.

“It’s about how much they can charge, how much the market can take,” said Ge Bai, an associate professor at the Johns Hopkins University Carey Business School who studies hospital prices but was not affiliated with the study.

The paper’s authors suggest that publishing this pricing data — which they collected from state databases, health plans and self-insured employers — could empower employers to demand lower prices, effectively correcting how the market functions.

But, they acknowledged, there’s no guarantee that would, in fact, yield better prices.

One issue is that individual hospitals or health systems often have sizable influence in a particular community or state, especially if they are the area’s main health care provider. Another factor: If they are the only facility in the market area to offer a particularly complex service, like neonatal intensive care or specialized cardiac care, they have an upper hand in negotiating the price tag. In those situations, even if an employer is made aware that Medicare pays less, it doesn’t necessarily have the ability to negotiate a lower price.

“Employers and health plans in a lot of cases are really at the mercy of big, must-have systems. If you can’t legitimately threaten to cut a provider or system out of the network, it’s game over,” said Chapin White, a Rand policy researcher and Whaley’s co-author. “That’s when you come up against the limits of market-based approach.”

It wasn’t always this way, said Gerard Anderson, a Johns Hopkins health policy professor and expert in hospital pricing, who was also not involved with the study. Anderson began comparing Medicare prices to that of private insurance in the 1990s, when they paid virtually the same amount for individual services.

Since then, private health plans have lost the ability to negotiate at that same level, in part because many hospital systems have merged, giving the hospitals greater leverage. “Most large, self-insured corporations do not have the market power in their communities to take on the hospitals even if they wanted to do so,” Anderson said.

The RAND findings come as Democrats campaigning for 2020 are reopening the health care reform debate. Single-payer advocates argue, among other points, that covering everyone through a Medicare-like system could bring lower prices and increase efficiency to the rest of the country, or at least give the government leverage to negotiate a better price.

That’s certainly possible, but it isn’t guaranteed. Under single-payer, Anderson said, the challenge would be to make sure Medicare doesn’t simply end up paying more, or that cuts aren’t so dramatic that hospitals and doctors go out of business.

And there’s the political calculus, Ginsburg of Brookings noted. Hospitals, doctors and other health care industries are all influential lobbies and could successfully ward off any efforts to lower prices.

“It’s one thing to have regulatory control of prices. It’s another to set them low enough to make a difference,” he said.

Other strategies, such as a “public option” — which would allow people to opt into a government-provided plan but preserve multiple health care payers — could also make a difference, he said. Lawmakers on the state or federal level could limit what hospitals are allowed to charge for certain medical services, as Maryland does.

Some states have taken smaller-scale approaches, too, by tying their payment rates to a percentage of Medicare, rather than negotiating case by case. In Montana, state employees get coverage that pays about 230% of the Medicare rate on average — an arrangement that saved the state more than $15 million over two years.

For its part, the American Hospital Association, an industry trade group, points to the importance of lowering the cost of prescription drugs or reducing overuse, among other things.

Policy fixes are debatable, White said. But the data makes one point clear: From an efficiency standpoint, the current system isn’t working.

“There are right now the secret negotiations between health plans and hospitals,” and the system is “dysfunctional,” he said.

Study Results Encourage Collecting ‘Big Data’ During Annual Visit To Doctor To Detect Hidden Health Problems

Studying genome and molecular activities in patients is better than conventional medicine when it comes to detecting potential health problems, according to Michael Snyder, chair of the genetics department at Stanford University. But other researchers express doubts about costs and other issues. Public health news also looks at disaster preparedness, antibiotic resistant infections, drug safety in pregnant women, weedkiller and cancer, obesity and diabetes.

All That Political Uncertainty Over The Health Law Gave Insurers Some Of Their Best Financial Annual Performances Yet

Last year stood as the best financially for insurers in the individual market since 2011, with monthly average individual market gross margins per member more than doubling from $78 in 2017 to $167 in 2018. In other health industry news: the Elizabeth Holmes trial, health care claims, the False Claims Act, public health and TV shows, apps and more.

Three Board Members of Maryland Medical System Resign As Second Contract Adds To ‘Health Holly’ Kickbacks Scandal

Following the resignation of Baltimore Mayor Catherine Pugh for her alleged financial ties to medical firms, the board chairman of the University of Maryland Medical System and two other board members resigned Tuesday, including Dr. Scott Rifkin. His firm had an “active agreement” with the hospital providing software.

Effects Of Surgery On A Warming Planet: Can Anesthesia Go Green?

It was early morning in an operating theater at Providence Hospital in Portland, Ore. A middle-aged woman lay on the operating table, wrapped in blankets. Surgeons were about to cut out a cancerous growth in her stomach.

But first, an anesthesiologist — Dr. Brian Chesebro — put her under by placing a mask over her face.

“Now I’m breathing for her with this mask,” he said. “And I’m delivering sevoflurane to her through this breathing circuit.”

Sevoflurane is one of the most commonly used anesthesiology gases. The other big one is desflurane. There are others too, like nitrous oxide, commonly known as laughing gas.

Whichever gas a patient gets is inhaled, but only about 5% is metabolized. The rest is exhaled. And to make sure the gas doesn’t knock out anyone else in the operating room, it’s sucked into a ventilation system.

And then? It’s vented up and out through the roof, to mingle with other greenhouse gases.

The two frequently used gases are fairly similar medically; sevoflurane needs to be more carefully monitored and meted out in some patients, but that’s not difficult, Chesebro said.

Generally, unless there’s a reason in a particular case to use one over the other, anesthesiologists simply tend to pick one of the two gases and stick with it. Few understand that one — desflurane — is much worse for the environment.

And that bothered Chesebro. He grew up on a ranch in Montana that focused on sustainability.

“Part of growing up on a ranch is taking care of the land and being a good steward,” he said.

Now he lives in the city with his three kids and has gradually started to worry about their environmental future.

“When I look around and I see the stewardship on display today, it’s discouraging,” he said.

“I got depressed for a while, and so I hit the pause button on myself and said, ‘Well, what’s the very best that I can do?’”

He spent hours of his own time researching anesthesiology gases. And he learned desflurane is 20 times more powerful than sevoflurane in trapping heat in the Earth’s atmosphere. It also lasts for 14 years in the atmosphere, whereas sevoflurane breaks down in just one year.

Opening a big, black notebook filled with diagrams and tiny writing, he showed how he computed the amount of each gas the doctors in his group practice used. Then he shared their carbon footprint with them.

“All I’m doing is showing them their data,” Chesebro said. “It’s not really combative. It’s demonstrative.”

One of the doctors he shared his analysis with was Dr. Michael Hartmeyer, who works at the Oregon Anesthesiology Group with Chesebro.

“I wish I had known earlier,” Hartmeyer said. “I would have changed my practice a long time ago.”

Hartmeyer said he was stunned when Chesebro explained that his use of desflurane was the greenhouse-gas equivalent of driving a fleet of 12 Hummers for the duration of each surgical procedure. It’s “only” half a Hummer if he uses sevoflurane. Hartmeyer noted that outside the operating room he drives a Prius, a hybrid electric car.

“You try to be good,” he said. “You take shorter showers or [don’t] leave lights on, or whatever else. But you know there’s always more that we could probably do. But this was, far and away, a relatively easy thing that I could do that made a huge impact.”

The anesthesiology carts that get brought into operating theaters tend to have a row of gases to choose from. Hartmeyer was able to switch pretty much overnight.

Other anesthesiologists made the switch, too. And it didn’t hurt that sevoflurane is considerably cheaper.

Hartmeyer’s change saved his hospital $13,000 a year.

When Chesebro shared his findings with the anesthesia departments at all eight Providence Health hospitals in Oregon, they prioritized the use of sevoflurane. They now save about $500,000 a year.

Providence’s chief executive, Lisa Vance, said the hospital system didn’t change its use of the gas because of the money. It changed because the World Health Organization now says climate change is the No. 1 public health issue of the 21st century — and because of Chesebro.

Vance said Chesebro teared up in front of 2,000 people when talking about the gas, his children and the Lorax character created by Dr. Seuss.

“Unless someone like you cares a whole awful lot, nothing’s going to get better — it’s not,” said Vance, quoting the book “The Lorax.”

Dr. Jodi Sherman, an associate professor of anesthesiology at Yale School of Medicine, called Chesebro’s efforts remarkable and important.

She said several hospitals around the country have tried to make this shift, but with mixed results. Some just gave anesthesiologists the information and not much changed. Other hospitals took desflurane away, but that left many anesthesiologists feeling disrespected and angry.

Chesebro succeeded, she said, because he chose to persuade his colleagues using data. He showed doctors their choice of gas plotted against their greenhouse impact. And it helped that he showed them over and over, so doctors could compare their progress to their peers.

“Providing ongoing reports to providers is the best way for this movement to catch on and grow,” she said. It can reinforce over time, she added, not just what their carbon footprint is, but also what progress they’re making.

Sherman said efforts such as Chesebro’s are sorely needed because the U.S. health sector is responsible for about 10% of the nation’s greenhouse gases.

“We clinicians are very much focused on taking care of the patient in front of us,” she said. “We tend to not think about what’s happening to the community health, public health — because we’re so focused on the patient in front of us.”

In an emailed statement, one of the largest manufacturers of both the anesthesia gases — Baxter International — said it’s important to provide a range of options for patients. The company also said inhaled anesthetics have a climate impact of 0.01% of fossil fuels.

“The overall impact of anesthetic agents on global warming is low, relative to other societal contributors, especially when you consider the critical role these products have in performing safe surgical procedures,” the statement reads.

It’s a fair point, Chesebro said, but he has a counterargument.

“Well, if it’s there, it’s bad. And if I can reduce my life’s footprint by a factor of six … why wouldn’t you do it?’”

The surgery Chesebro was involved in that morning at Providence was a success. Chesebro estimates that by using sevoflurane on his patient, the amount of greenhouse gases produced was the same as in a 40-mile drive across the Portland region. If he’d used desflurane instead, he said, it would have been like driving the more than 1,200 miles from Seattle to San Diego.

Now Chesebro’s hospital bosses are hoping other doctors will follow his lead, research their own pet peeve and maybe solve a problem no one’s thinking about.

This story is part of a partnership that includes Oregon Public BroadcastingNPR and Kaiser Health News.

Drug Industry Patents Go Under Senate Judiciary Committee’s Microscope

Congress isn’t making much headway in finding a solution to the problem of soaring prescription drug prices, but lawmakers from both parties are tinkering on the edges with legislation that aims to increase competition among drugmakers.

A comprehensive piece of drug-pricing legislation is a high priority for Senate Finance Committee Chairman Chuck Grassley, (R-Iowa) and Sen. Ron Wyden (D-Ore.). And it could be introduced by mid-June, according to congressional staff.

But while that is hashed out, a slate of options to reform drug patents is working its way through the Senate Judiciary Committee, which had a hearing Tuesday featuring academics, patient advocates and a representative from the pharmaceutical industry. Their mission: to increase competition without decreasing innovation in the industry.

“I think we’re dangerously close to building a bipartisanship consensus around change,” Sen. Dick Durbin (D-Ill.), said during the hearing.

The four proposed bills share a common goal: avoiding some of the thorny issues around drug pricing, like whether the government will set drug prices or negotiate with manufacturers on what federal programs will pay. Instead, the patent reform proposals get at the ways branded drug manufacturers use patents, and the legal monopolies that are granted with patents, to keep lower-priced generic competitors from reaching patients.

“A package of patent reforms are important because they fix systemic problems that allow prices to go up and keep them high,” testified David Mitchell, the president of Patients for Affordable Drugs, a Washington, D.C.-based advocacy group focused on lowering prescription drug prices.

Sen. John Cornyn (R-Texas) offered specific examples of drugs that have benefited from  system issues, including Humira, an expensive drug for arthritis and psoriasis that is protected by 136 patents.

That’s called a “patent thicket,” because it prevents a generic alternative from entering the market for more years — in this case, until 2023 for a drug first approved for use in the United States in 2002. “Is there anyone on the panel who’d like to defend the status quo?” he asked.

“There is no way a biosimilar can deal with a hundred patents,” testified Michael Carrier, a professor at Rutgers Law School. “This is an abuse of the system.”

Among the proposed bills, the Stop STALLING (“Stop Significant and Time-wasting Abuse Limiting Legitimate Innovation of New Generics”) Act, is the bipartisan brainchild of Sen. Amy Klobuchar (D-Minn.) and Grassley. The bill is supposed to put a stop to “sham” citizen petitions to the FDA. Critics say these petitions are often introduced by drugmakers under the guise of patient advocacy to slow FDA approval of new generic medicines. “Nearly every one of these citizen petitions is brought by a brand company. None are filed by individuals. I love the legislation. I would go even stronger,” Carrier said.

Grassley is also the lead sponsor on the bipartisan Prescription Pricing for the People Act of 2019. It directs the Federal Trade Commission to investigate mergers of pharmacy benefit managers, the middlemen that negotiate between drugmakers and health plans.

Klobuchar and Grassley teamed up again on another measure, the Preserve Access to Affordable Generics and Biosimilars Act, which they  say would end “anti-competitive behavior” — specifically, deals struck between branded companies and generic companies to keep a generic, or a biosimilar, off the market. Klobuchar,  a Democratic presidential candidate, has frequently discussed her opposition to this practice on the campaign trail.

James Stansel — the executive vice president and general counsel of the Pharmaceutical Research and Manufacturers of America, a drug industry trade group, and the lone voice of the pharmaceutical industry on the panel — cautioned against moving too aggressively on this point. “We want to make sure we don’t do something that’s anti-competitive in the hopes it would be pro-competitive,” he said.

There’s also the CREATES (“Creating and Restoring Equal Access to Equivalent Samples”) Act, introduced by Sen. Patrick Leahy (D-Vt.) with 31 bipartisan co-sponsors and endorsed by nearly every witness on Tuesday’s panel. It’s supposed to crack down on branded companies that refuse to sell samples of their drugs to generic companies, a necessary step to increasing the number of generics on the market.

Versions of all four of those bills have also been introduced in the House and advanced out of the House Judiciary Committee.

“The American people are being played for chumps,” said Sen. John Kennedy (R-La.). “Just chumps. And it’s got to stop.”

Feds Want To Show Health Care Costs On Your Phone, But That Could Take Years

Federal officials are proposing new regulations that for the first time could allow patients to compare prices charged by various hospitals and other health care providers using data sent to their smartphones.

Donald Rucker, who coordinates health information technology policy for the Department of Health and Human Services, said he expects that the rules, first proposed in March, will give patients new power to shop for care based on price and quality.

Consumers have long sought more knowledge about health care prices, but administration officials cautioned it could take two years or more for it to appear in a user-friendly form on a phone app. Many specifics, including how patients would make sense of complex pricing policies for purchasing health care and insurance and assessing quality via an app, remain unclear.

Rucker said in remarks prepared for a Senate Health, Education, Labor & Pensions Committee hearing Tuesday that patients “have few ways if any to anticipate or plan for costs, lower or compare costs, and, importantly, measure their quality of care or coverage relative to the price they pay.”

The Trump administration proposal comes amid growing outrage from patients hit with seemingly exorbitant “surprise” medical bills. One study found that these bills — which are for amounts far more than the patient anticipated or for care not covered by insurance — have bedeviled more than half of American adults.

The Senate committee is reviewing regulations proposed under the 21st Century Cures Act, a law passed in 2016 to promote innovation in health care.

Dr. Kate Goodrich, the chief medical officer for the federal government’s Centers for Medicare & Medicare Services, said the agency wants every American to have an electronic health record (EHR) that will follow them as they move through the health care system, “giving them the data they need to make the best decisions for themselves and their families.”

Everyone, Goodrich said in her prepared statement to the committee, “should be able, without special effort or advanced technical skills, to see, obtain, and use all electronically available information that is relevant to their health care, and choices — of plans, providers, and specific treatment options.”

Meeting these goals could prove to be a tall order. For well over a decade, federal officials have struggled to set up a digital records network capable of widespread sharing of medical data and patient records. In 2004, President George W. Bush said he hoped to have a digital record for most Americans within five years. In early 2009, the Obama administration picked up the challenge and funneled billions of dollars in economic stimulus money into a campaign to help doctors and hospitals buy the software needed to replace paper medical files.

Critics argue that poor oversight over the stimulus spending and objectives has saddled many doctors and hospitals with flawed software that typically cannot share information across health networks as promised. It has also caused new types of errors that compromise the safety of patients.

Botched Operation,” a recent investigation published by Kaiser Health News and Fortune, found that the federal government has spent more than $36 billion on the EHR initiative. Thousands of reports of deaths, injuries and near misses linked to digital systems have piled up in databases over the past decade — while many patients have reported difficulties getting copies of their complete electronic files, the investigation found.

Despite the slow progress, federal officials remain optimistic that digital records will save the nation billions of dollars while reducing medical errors, unnecessary medical testing and other waste — and encouraging more Americans to take a bigger role in managing their health care by comparing prices.

But Sen. Lamar Alexander, R-Tenn., the committee’s chairman, said the results would have been better had officials not rushed out the stimulus plan. “I am especially interested in getting where we want to go with input from doctors, hospitals, vendors, and insurers, so we have less confusion, make the fewest possible mistakes, and make sure we don’t set some kind of unrealistic timeline,” he said in a statement.

Anger over the lack of easy access to health care has dominated public comments on the proposed regulation posted on a government website.

“The proposed policy to mandate disclosure of health care pricing by hospitals, insurance companies, etc. is one of the most important in American history. That is not hyperbolic,” one anonymous commenter wrote, adding: “The only way to save money on healthcare in America is to never receive it.”

Candidates Should ‘Be Honest’ With Voters About Harsh Realities Of ‘Medicare For All,’ 2020 Hopeful Sen. Bennet Says

Sen. Michael Bennet (D-Colo.) says his opponents need to tell Americans the truth about the negative sides of “Medicare for All.” Bennet and Sen. Tim Kaine (D-Va.) rolled out their “Medicare X” plan last month that would allow for a public health care option, modeled after Medicaid, to be made available alongside private insurance. Politico looks at where all the candidates stand on universal health care, among other things.

Federal Regulations Weren’t The Reason Insurers Shied Away From Selling Over State Lines, Health Companies Say

CMS wants to make it easier for insurers to sell across state lines, but those companies say it’s not regulations that are stopping them. “These states have each taken a different approach, none of which has, to date, resulted in insurers offering comprehensive health insurance in a state in which it is not licensed,” the National Association of Insurance Commissioners said in a comment letter. “This shows that the impediments to interstate sales are not in federal law but are inherent in the business of health insurance.” In other health law and insurance news: accountable care organizations, preexiting conditions protections, and enrollment.

In Nursing, Experiencing Trauma And The Resulting PTSD Is A Fact Of Life

As many as one in four nurses experience PTSD at some point in their careers. The stressful environment of nursing can support many the “triggers and traumas of PTSD,” Dr. Mealer said. “Nurses see people die. They work on resuscitating patients. They try to control bleeding. They have end-of-life discussions. And sometimes they are verbally or physically abused by patients or visiting family members.”

Cancer-Detecting Software Shows Promise To Read Genetic Material For Treatment Clues, But Results Can Be Spotty, Study Shows

“With all honesty, we are in the early stages” of applying artificial intelligence to cancer care and research, said Dr. Bernardo Goulart, lead author of the study. Other news on technology and health looks at future challenges of certifying devices, data breaches, patients rights and social care networks.

Parents Of Children With Rare Genetic Disorder See Hope In Drug Trial, But Others See Litany Of Red Flags

Ovid Therapeutics’ drug for Angelman syndrome–a rare cognitive disease that currently has no treatment–saw a glimmer of success in a very small trial. The drug had beaten the placebo on only one metric and failed on a full 16 others, including measures of quality of life and ability to sleep. To investors, the ostensibly positive data looked cherry-picked. In other news at the convergence of pharma and public health: Alzheimer’s, dengue fever, superbugs, statins and more.