The Fair Pricing Act: A Historic Step Toward Affordable Healthcare
Demand fair prices for routine medical services, no matter where they’re delivered.
With almost 60% of doctors offices now owned by hospitals or corporations, there has been an outsized growth in healthcare costs associated with outpatient services that were traditionally performed in a doctor’s office. Essentially the service is the same, the quality of care is the same but patients are paying more without added value in return because hospitals own the building.
According to a recent report by the 32BJ Health Fund, if all services that Medicare has determined are safe to provide in doctor’s offices were to be priced at the average doctor’s office rate instead of the hospital outpatient department rate, the NYS public employees and retirees plan could save an estimated $206 million in one year and the NYC employee health plan could save an estimated $176 million in one year.
The Fair Pricing Act offers a unique and much needed remedy by capping prices for low-complexity, routine medical services at 150% of Medicare such that the same procedure costs the same price regardless of the setting in which it’s provided. This would help lower health benefit expenses for payers, like employers and government entities, and also make healthcare more affordable for patients.
Fair Pricing Act Key Provisions:
- Providers must deliver covered services to all insured and uninsured patients at prices that do not exceed 150% of Medicare, based on the doctors’ office rate for the same services.
- Health insurers that contract with a NYS healthcare provider cannot reimburse them more than the price cap for covered services – and cannot hold plan participants liable for paying amounts more than the price cap.
- Bans hidden facility fees for the covered routine outpatient services.
- Protects patients from being responsible for paying amounts exceeding the price cap rates through copays or deductibles.
- The Department of Health and the Department of Financial Services will each have roles in collecting data, producing reports, and implementing the policy in a way that holds regulated entities accountable.
- Healthcare providers and health insurance carriers may be subject to fines for violating relevant provisions, and contracts may be referred to the Attorney General for compliance review.
- Any party who suffers a loss due to violation of this law is entitled to seek all remedies, damages, costs, and fees available under New York’s consumer protection statute.
You can read the full text of the bill here: https://www.nysenate.gov/legislation/bills/2023/S9952