Lamont Proposes Legislation To Reduce Health Care Costs

CONNECTICUT — Gov. Ned Lamont announced that he has submitted legislative proposals to the General Assembly that focus on reducing health care costs for Connecticut residents.

The legislation is House Bill 6669, An Act Protecting Patients and Prohibiting Unnecessary Health Care Costs, and Senate Bill 983, An Act Limiting Anticompetitive Health Care Practices.

“Gallup recently reported that record-high numbers of Americans are putting off care due to costs,” Lamont said.

The governor made the announcement during a news conference in New Britain Tuesday,

Approximately 38 percent of Americans put off care in 2022, the highest percentage Gallup has ever seen in its 22 years of polling. Two-thirds of personal bankruptcies are related to medical debt, the most common cause of bankruptcy, and healthcare is consuming a larger and larger percentage of GDP, now more than 18 percent, according to Lamont.

The legislation:

• Eliminates hospital facility fees charged at free-standing offices and clinics.
• Implements stronger regulatory enforcement tools at the Connecticut Office of Health Strategy to assure compliance with certificate of need requirements and related conditions of approval, such as cost controls, patient access, and detailed reporting. This will curb health care costs by preventing duplicative services in specific areas, while ensuring availability and access to critical services in all parts of the state.
• Commits Connecticut to joining a multistate bulk purchasing consortium to negotiate prescription drug discounts that all of the state’s residents will be able to access through a discount card at their pharmacy.
• Requires the Connecticut Office of Health Strategy to annually publish a list of prescription drugs that are experiencing major price spikes to inform consumers and prescribers about which drug prices are going up and by how much.
• Reins in aggressive marketing practices by pharmaceutical representatives to ensure prescribers get clear and accurate information about the drugs they prescribe and generic alternatives. Pharmaceutical representatives will be required to complete a training, register with the state, and disclose relevant information about drug costs and efficacy across different races and ethnicity, if known.
• Strengthens protections to ensure that discounted prescription drugs purchased through the federal 340B program benefit the low-income consumers and communities the program was designed to help.
• Prevents price gouging when patients get care from a provider who is not in their network. Specifically, the governor is proposing to limit out-of-network costs for inpatient and outpatient hospital services to 100% of the Medicare rate for the same service in the same geographic area.
• Outlaws the use of anti-competitive contracting practices that have been used by health systems to impede competition and increase prices. This will provide health insurers with additional bargaining power to make it easier to negotiate affordable prices for consumers.

These include:

• Anti-tiering clauses: Requiring a health plan to extend a preferred value tier status to all facilities or provider in a health system, even if certain providers do not meet cost or quality standards for that tier.
• Anti-steering clauses: Prohibiting insurers from using incentives to steer patients to higher value providers.
• All-or-nothing clauses: Requiring health plans to accept all providers in a healthcare system or none of them.
• Gag clauses: Preventing parties from disclosing relevant information, including price or terms of an agreement to a third party.

Dr. Deidre Gifford, executive director of the Connecticut Office of Health Strategy, said, “It is clear that hospital inpatient, hospital outpatient, and retail pharmacy costs are the largest contributors to the health care affordability problem. Health system consolidation and lack of competition is also contributing. These multi-pronged proposals address major cost drivers in these areas and expand on our continuing efforts to contain medical costs.”