Health Policy Congressional Update: A New Series of Healthcare Reform Bills Moves Forward in the House

Healthcare transparency and healthcare competition have been two prominent topics being discussed in both the House and Senate in 2023. Since the beginning of the year, several Congressional committees have held meetings focusing on increasing transparency in the healthcare market, improving efficiency and reducing abuses in federal healthcare programs, improving competition in an industry becoming quickly over-consolidated, and decreasing rising drug costs.

On May 17, 2023, the House Energy & Commerce Health Subcommittee held a markup session on 17 bills addressing the high cost of healthcare and the need to improve transparency and competition in the healthcare industry. LUGPA’s Washington team attended this meeting and reported on the proceedings.

The main bill discussed in the meeting was H.R. 3281, the Transparent PRICE Act. This bill became the primary vehicle for many of the reforms discussed over the last two months in the committee when Committee Chair Rep. Cathy McMorris Rodgers combined several proposals from other bills into one significant amendment submitted in the nature of a substitution (AINS). This new amendment incorporated several other important reform proposals into the transparency bill, including:

  • Reforms that would increase accountability in billing to ensure hospital outpatient departments (HOPDs) are paid at the correct rate;
  • Reforms to ensure patients can shop for the same lab test they can shop for at hospitals and other laboratories;
  • Transparency reforms requiring pharmacy benefit managers (PBMs) to report to employers and employees the prices PBMs pay to help their clients save money;
  • New requirements increasing transparency in changes in ownership;
  • New reforms requiring Food and Drug Administration (FDA) guidance on generic drug applications regarding quantitative differences in ingredients;
  • New rules ensuring that Medicare beneficiaries do not pay more for drugs that are administered in a hospital-based outpatient department (HOPD) than in a physician’s office by reducing the HOPD rate to the physician fee schedule (PFS) rate; and
  • New rules banning the use of spread pricing in the Medicaid program.

LUGPA has submitted testimony and comments on several of these proposals, most notably the reforms proposed for PBMs, spread pricing, and drug billing. One proposal discussed during the meeting but not advanced by the committee was site-neutral billing, a reform that LUGPA strongly supports.

During the consideration of H.R. 3281, Chair McMorris Rodgers offered and subsequently withdrew an amendment that would implement the MedPAC site neutrality proposal that was discussed in a previous hearing in April. LUGPA supports this reform and will continue working with committee members to advance the proposal.

For more information on the meeting, including the complete list of bills and their summaries discussed, the committee has provided a markup memo, which can be found here.

LUGPA’s Washington team noted several bills that were discussed during the meeting as the main items of interest for LUGPA members:

This bill combined many of the proposals included for markup and some additional proposals. The bills incorporated into H.R. 3281 include:
Requires PBMs to regularly furnish employers with detailed data on prescription drug spending. It also requires a report from the Comptroller to Congress on the effects of PBM services on pharmacy networks, group health plans, and health insurance issuers.
Requires hospitals, freestanding emergency centers, ambulatory surgery centers, physician practices with more than 25 physicians, and physician practices owned by hospitals, insurance companies, and other entities to report to HHS changes in ownership. Data would be used for annual reports on trends in consolidation.
Requires each provider department to include a unique identification number on claims for services and requires hospitals with an outpatient department of a provider to submit to the Centers for Medicare and Medicaid Services (CMS) an attestation concerning each outpatient department.
Establishes deductible and cost-sharing limitations on highly rebated drugs – capped at the price paid by the insurer for the drug in the previous year.
Requires the Health and Human Services Department (HHS) to consider the implications of provider payment rule proposals on consolidation.
Establishes reporting requirements for hospitals participating in the 340B Program.


Each of these proposals advanced out of the committee.

LUGPA strongly supports both healthcare price transparency and improving healthcare competition. We have included both issues in our top legislative priorities.

In our previous testimony to the Committee, which was included in the record and posted on the committee’s website, LUGPA’s called on Congress and the Administration to:

  • Enforce the hospital transparency rule, which will assist patients in making prudent decisions on where to get their health care;
  • Support independent physician practices by equalizing payments for similar services across different sites of service;
  • Require a minimum level of charity care (e.g., 3.8% -- the average amount provided by for-profit hospitals) for a hospital to earn a non-profit designation to be exempt from taxation and eligible for the 340B drug program;
  • Repeal the inpatient-only list; and
  • Reform the Stark law to eliminate the prohibition of physician ownership of hospitals and codify and simplify the reforms to value-based entities implemented through regulation in 2020.
  • LUGPA’s March 28 testimony is available online for more information on healthcare price transparency.

LUGPA’s March 28 testimony is available online here. We will continue to monitor this legislation and comment more over the coming months.