On tape, then the statute
The cameras love a vial. This is the night: a must-have emergency department, a commercial contract at 2–3× Medicare, and a plan that does not invent that multiple — it passes it through. Watch people in the job try to post the number, stop the merger, pay the same for the same chair, and kill the ambush bill. Then read what actually became law. The political action page is the rulebook. The drug voices page is the pharmacy. This is the tower.
Donald Trump · Amy Klobuchar · Jodey Arrington · Cathy McMorris Rodgers · Lamar Alexander
Brand drugs are ~4× a peer national list. The hospital night is 2–3× the public rate because Congress never set a commercial hospital rate and the system can walk away from a plan that tries. Maryland is the live US proof that one stay can have one rate. Insulin hearings fill a room. Hospital pricing rarely gets the same hearing.
Drug voices · Historical voices · Patient voices · Evil · Why the night is 2–3× · Maryland · No commercial hospital rate
2019 · White House · hospital
Donald TrumpWhite House — Honesty and transparency in health care prices (Nov 15)
We are finalizing a rule that will compel hospitals to publish prices publicly online for everyone to see and to compare. We’re stopping American patients from just getting — pure and simple, two words — ripped off. Because they’ve been ripped off for years.
WantsA cash-style list before the stay: shoppable services, negotiated rates, not a chargemaster PDF nobody can use. He says the hospital will not like him for it.
On this siteThe American Hospital Association sued this rule (AHA v. Azar) and lost in the D.C. Circuit. The files still are not a cash menu. Fines have been small next to a 2–3× night. The plan does not write that multiple — the must-have system extracts it and the plan passes it through. Posting a secret is not the same as one rate.
2021 · Senate Judiciary (antitrust subcommittee chair) · hospital
Amy KlobucharSenate Judiciary — Antitrust Applied: Hospital Consolidation Concerns and Solutions
We have had about 1,600 hospital mergers in this country in the last 20 years. Ninety percent of all metropolitan areas have highly concentrated hospital markets. We’ve also seen hospitals buying physician practices at a fast pace, and now about one-third of all doctors work for a hospital.
WantsStop the merger before the market has one must-have tower. Give FTC and DOJ the staff to review the deals that are too small to report. When a merger is anti-competitive, stop it — not a press release after the 3× is already the contract.
On this siteThis is the bullying. The job plan cannot drop the emergency department. After the merger there is nowhere else to send the night, so commercial is 2–3× Medicare (RAND) — not because the plan invented the sticker. COPA statutes and under-enforced cross-market deals are how the system got this big. You cannot un-merge with a memo.
Consolidation, then the 3× · No commercial hospital rate · RAND hospitals
2024 · House Budget (then chair) · hospital
Jodey ArringtonHouse Budget — Breaking Up Health Care Monopolies
There were over a thousand hospital mergers between 2002 and 2020. Research has revealed the average price of hospital services increased by $521 after hospital mergers occur. CBO stated that consolidation has increased federal health spending and costs for patients. Site-neutral payment reform is a Democrat and Republican idea. It emanated with President Obama. We agree with it.
WantsPay the same Medicare rate for the same service in a hospital outpatient department and a physician office. Stop the incentive to buy the clinic, flip the sign, and bill the extra. He says rural should be carved out. He wants the House site-neutral slice into law.
On this siteThe $521 is the merger tax on the service, not the whole 2–3× night — RAND is still the commercial multiple. Site-neutral is the American Hospital Association’s federal hill. The Lower Costs, More Transparency Act put a slice of it in a House-passed bill. The Senate did not make it law. The HOPD extra remains. Medicare is not ‘true worth.’ It is the posted public rate. Commercial is the private contract on top.
Site-neutral — House only · The outpatient extra · MedPAC, year after year
2023 · House Energy & Commerce (then chair) · hospital
Cathy McMorris RodgersHouse floor — Lower Costs, More Transparency Act (H.R. 5378)
We heard about a patient who was overcharged eleven thousand dollars by a hospital for services she didn’t receive. The Lower Costs, More Transparency Act lowers costs through increased health care price transparency. It ensures that senior citizens on Medicare never pay more for a drug because of where it is administered.
WantsCodify hospital price posting. Equalize Medicare payment for the same drug in a hospital outpatient chair and a physician office. Bipartisan, regular order, scored as savings. She is asking the Senate to take the package.
On this siteThe House passed it 320–71. The American Hospital Association opposed the site-neutral slice and the Senate never made it a statute. Transparency-as-law was the easy half; the extra on the infusion chair was the hill. Maryland is still the live US proof that one stay can have one rate, whoever pays. This bill was not all-payer. It was a file and a smaller extra.
What the House passed · Files, not a menu · Maryland all-payer
2020 · Senate HELP (then chair) · hospital
Lamar AlexanderSenate HELP — surprise medical billing (July 29)
Patients have demanded protection from surprise medical bills for years. They need it in the middle of a global pandemic, and permanently after the crisis is over. Progressive Democrats and conservative Republicans have agreed on a transparent, market-based solution. The American people can’t afford to wait any longer.
WantsIf you are in an in-network hospital — or in the emergency department — the out-of-network doctor in the hallway cannot send a second bill. Take the patient out of the fight. Let plans and hospitals fight the rest in dispute resolution.
On this siteThis is the bill that became the No Surprises Act, inside the year-end package. It is the hospital clip that actually became law. It does not set the in-network 2–3×. It stops the ambush bill, not the secret commercial contract. Hospitals and air ambulance have spent the years since litigating the independent-dispute formula so the award stays fat.
No Surprises Act · The missing rate · The night that is still 2–3×
The hallway: Drug voices · Historical voices · Patient voices · Evil · Political action · Problems / solutions · Negotiation · The 5% — hospital · Flagship · The plant · Evidence