Rep. Tulsi Gabbard Pushes to Reduce Healthcare Costs, Inefficiency

Press Release

Congresswoman Tulsi Gabbard (HI-02) this week cosponsored two bipartisan bills to increase affordability and efficiency in the healthcare industry. The congresswoman cosponsored the Medicare Audit Improvement Act (H.R. 1250) and the Patients Access to Treatments Act (H.R. 460).

"All people deserve access to affordable, quality healthcare and a system of care that is transparent and efficient," said Congresswoman Tulsi Gabbard. "It is absolutely unacceptable that some auditors and insurance companies take advantage of our healthcare system for their own monetary benefit by fraudulently denying Medicare payments or making prescription drugs unaffordable to people who need them the most. I am co-sponsoring two bills that will reduce inefficiencies and wrongful payment denials, and also make sure that certain drugs are affordable, especially for people fighting cancer, multiple sclerosis, or chronic arthritis, for example. No sick patient should lose access to treatment, or have to pay excessive prices, because of blatant abuse, inefficiencies, or fraud in the system. No patient should be forced to choose between medicine or groceries because of skyrocketing prescription costs."

The Medicare Audit Improvement Act establishes limits for the number of medical records requests that can be made by Recovery Audit Contractors (RACs). RACs are private organizations that contract with the Centers for Medicare and Medicaid Services to identify and collect improper payments made by Medicare to healthcare providers. RACs are paid on commission, which incentivizes them to make inaccurate denials and create inefficiencies in the process. RACs often deny claims similar to those that have been overturned on appeal, gaining their commission and forcing health providers to go through the same appeal process repeatedly.

The Patients Access to Treatments Act prohibits insurance companies from charging more for specialty drugs in a "Tier-4" prescription category. Currently, companies typically charge for Tier-1 generics, Tier-2 brand medications, and Tier-3 off-formulary brand medications, increasing in price in each tier. Insurance companies have moved toward using a Tier-4 category for specialty drugs and charge a percentage of the drug cost instead of a co-pay. If patients are charged this way, the cost of specialty drugs could jump from hundreds of dollars per month to thousands of dollars, making it unaffordable for patients suffering from multiple sclerosis or cancer, for example, to receive the treatment they need.

Source