Loopholes Prevent People from Easily Identifying Unreasonably Expensive Health Care Plans in an Effort by Insurers to Keep Prices High
WASHINGTON – U.S. Senators Maggie Hassan (D-NH) and Mike Braun (R-IN), both members of the Senate Health, Education, Labor, and Pensions Committee, are urging the administration to close loopholes that some insurance companies are exploiting to hide their health plan prices from the public.
Last year, the Centers for Medicare & Medicaid Services (CMS) required insurance companies to publicly release in- and out-of-network rates for their health care plans. This rule aims to lower prices by making it easier for people and businesses to identify unreasonable prices and excessive price increases from health care providers. However, some insurance companies have exploited loopholes and continue to obscure the costs of their plans.
“While some insurance companies are complying with CMS’ rule, others may be relying on gaps to evade accountability,” the Senators wrote. “According to reports, insurance companies have provided information in an indecipherable structure, omitted important pricing information, and stuffed the information into files too large for anything but a supercomputer to process.”
The Senators continued, “As a result, employers and researchers have been unable to use the data to assess the drivers of high health care costs and target solutions.”
In their letter, the Senators note that experts have highlighted potential avenues to close these loopholes, including urging CMS to limit file sizes, to create a standardized reporting template, and to increase enforcement of insurance companies that provide low-quality data, or no data at all.
The letter is part of Senators Hassan and Braun’s continued effort to bring down health care costs. Recently, the pair introduced bipartisan legislation to close a loophole that Big Pharma can exploit to block competition from better alternative drugs, including generic drugs, and keep drug prices high. Senators Hassan and Braun also previously called for robust enforcement of key health care price transparency requirements in a letter to CMS. Additionally, the most recent government funding bill, which is now law, also included three bipartisan measures back by Senator Hassan to increase access to generic and biosimilar medications. And Senator Hassan led successful bipartisan efforts to help eliminate surprise medical billing, which has prevented at least 9 million surprise bills.
Read the letter here.