Congress must address the health care cost crisis now

OPINION:

Our health care system has a pressing need for greater competition and transparency.

A recent Mercer survey showed that American business owners are in for the highest health care benefit cost increase in 15 years. Health benefit costs per employee are expected to jump an average of 6.5% next year. As someone who speaks with employers and human resources professionals every day, I can attest that health care costs are, by an order of magnitude, their most daunting challenge.

Out-of-control health care prices are hurting our economy and trickling down to employees through higher premiums, deductibles and out-of-pocket costs. Companies and working families are reaching the breaking point. The good news is that solutions already exist — carefully crafted policy proposals with broad, bipartisan support. The only thing missing is congressional action.

Congress is entering the fourth quarter, and the game clock is ticking.

Employers who sponsor health care benefits rarely know the true cost of care, and patients often learn of costs only after receiving the care they need. Consolidated hospital systems tack on facility fees that have nothing to do with the service provided. Pharmacy benefit managers profit through spread pricing and rebate games that inflate prescription costs. Patent gamesmanship keeps cheaper drugs off the market. These problems are obvious to nearly everyone familiar with the health care industry.

The administration has taken unprecedented action to bring about greater transparency and lower costs and begin holding hospitals and insurers accountable. President Trump’s executive orders address these issues as a crucial first step toward needed reform, but lasting change and accountability ultimately require Congress to act.

The good news is that much of the hard work has already been done.

In December, House and Senate leaders put forth a bipartisan health care package that would have taken important steps toward pharmacy benefit managers’ transparency and accountability, honesty in hospital billing and prescription drug patent reforms. Unfortunately, political maneuvers that had nothing to do with these provisions swamped the bill. Congress closed the year again with nothing to improve affordability and transparency.

Bills under consideration in Congress would move the ball forward in meaningful ways. The Patients Deserve Price Tags Act (S.2355) would require transparency in health care prices and guarantee employer plan sponsors access to their health care claims data. A Better Care Act is also expected to be reintroduced, aimed at curbing abusive hospital contracting practices that restrict patients’ freedom to choose affordable, high-quality care. These and site-neutral payment policies to end unfair billing disparities remain strong starting point proposals with proven support across party lines.

The solutions to the pharmacy benefit managers problem are clear: Congress should require accountability and unrestricted transparency into the “black box,” ban so-called spread pricing, require 100% pass-through of rebates and other payments from drug manufacturers, and hold pharmacy benefit managers to the same standards applied to employers.

Polling data demonstrates broad public support for these reforms. According to one PatientRightsAdvocate.org survey, 96% of Americans say they should know health care prices up front.

Employers are also navigating this broken, inefficient system. American businesses should not be left to subsidize the lack of transparency, accountability and fair competition in the health care industry. Rather, all payers — patients, workers, employers and the American taxpayer — need reforms that bring down prices for everyone.

Every day that goes by until the end of the year makes it harder to get these necessary reforms across the finish line. At a minimum, Congress must pass the bipartisan, bicameral health care package from December. The window for action is closing fast, but there’s still time to deliver for everyday Americans. All that’s missing is a Congress that is ready and willing to get into the game.

• James Gelfand is president and CEO of The ERISA Industry Committee.