Todd Crawley

First, Congress must repeal and replace the “Big Ugly Bill.” Restoring investments in healthcare, education, student aid, nutrition assistance, and other family-supporting programs that help families succeed would provide critical support for Americans striving to achieve economic self-sufficiency.

Secondly, Enact legislation to enforce federal price transparency rules for hospitals and insurance plans, as well as establish additional state-level requirements. As of January 2021, hospitals are required to publish pricing information in two formats : a consumer-friendly list of 300 “shoppable services” and a comprehensive machine-readable file for all items and services. The Centers for Medicare & Medicaid Services found that 70% of hospitals have successfully met federal transparency requirements. Other estimates, however, have shown the percentage of hospitals in compliance to be much lower. CMS recently released updates to enforcement processes in April this year.

Additionally, Reference-based pricing. This methodology prices a claim or bill for medical services starting at a benchmark or reference price. Using this methodology, a payer will set a price range or cap prices for each health care service instead of negotiating the prices with providers, using a reference point like Medicare or the national average pricing for their payment.

Finally, Expand the Inflation Reduction Act (IRA) to allow Medicare to negotiate prices for a broader selection of high-cost drugs each year and establish an independent state Prescription Drug Affordability Boards (PDABs) to set upper payment limits on prohibitively expensive medications.

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