April 4, 2017


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CMS Delays Implementation of Bundled Payment Model

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Antitrust Legislation
Passes House

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Antitrust Legislation Passes House

On March 22, 2017, the House easily approved a bill that Republicans have said is part of their broader plan to remake the health care system. According to House Majority Leader Kevin McCarthy (R-CA), the Competitive Health Insurance Reform Act (H.R. 372) “makes needed reforms to the McCarran-Ferguson Act to reduce health care costs for consumers by ensuring competition.” McCarthy further stated that the legislation will protect consumers from consolidation in the health care marketplace and restore competition to the health care industry, “bringing down costs and expanding choices for American consumers.”

“Our legislation also maintains the ability for insurers to engage in certain collaborative activities—like data sharing—that don’t compromise the spirit of fair competition,” McCarthy stated. “The President indicated he will sign this legislation when it gets to his desk, as the White House said it supports all efforts to restore competition to the health insurance marketplace in order to lower costs and expand choices for consumers.”
“Many Americans have seen their health insurance premiums increase, and health care options decrease, significantly under the Affordable Care Act,” the White House stated. “H.R. 372 would amend the McCarran-Ferguson Act to ensure that Federal antitrust laws apply to the business of health insurance. The bill supports the goal of giving American families and businesses more control over their own healthcare choices by promoting greater health insurance competition. The bill would specifically prohibit businesses from engaging in anti-competitive practices, including price fixing, bid rigging, and market allocation that could drive up healthcare costs.”

The AAOS has raised the issue of this exemption for health insurers, commenting that the antitrust exemption, “together with the recent health care industry consolidations,” has enabled a select few health plans to dominate the health care market. “As a result, physicians are frequently placed in positions of diminished bargaining strength, and health plans are able to impose unilateral, non-negotiable contracts,” AAOS wrote previously. However, AAOS has supported legislation that would go further and proactively protect health care professionals who are engaged in contractual negotiations with a health plan for the delivery of health care services from federal antitrust prosecution. While H.R. 372 may be a step in the right direction, further antitrust reforms may still be needed to allow health care providers to engage in care coordination endeavors without fear of antitrust prosecution.

For more on AAOS antitrust efforts, visit http://www.aaos.org/Advocacy/Antitrust/.