Congress is targeting anticompetitive provider-payer contract language with the Primary Care and Health Workforce Act of 2023. The bill specifically takes aim at contractual provisions that: require health insurers to contract with all of a health systems’ facilities (or none at all); prevent an insurer from including competing providers in-network; restrict insurers from steering patients to competitors; or, offer incentives to encourage patients to use certain providers. While such provider-payer contract provisions have historically been confidential, the growing number of lawsuits has lifted the veil on such anti-competitive practices and public awareness / outrage is growing. One study that has served as an impetus for the 2023 bill revealed that a C-section delivery in Sacramento cost more than $27,000 (in 2016) – more than double what it costs in Los Angeles or New York. Sacramento was identified as a market plagued with “all or nothing” contract provisions that resulted in higher prices for care and higher health insurance premiums for consumers.
Menu
