Bill Overview
Title: Addressing Anti-Competitive Contracting Clauses Act
Description: This bill requires the Government Accountability Office to study and report on the effect of certain anticompetitive contract clauses in contracts between health insurers and health care providers.
Sponsors: Rep. Spartz, Victoria [R-IN-5]
Target Audience
Population: People relying on health systems globally
Estimated Size: 330000000
- The bill requires the Government Accountability Office to study anticompetitive contract clauses between health insurers and healthcare providers.
- Healthcare providers and insurers are directly affected as they are parties in the contracts being evaluated under this legislation.
- Patients and consumers of healthcare services may indirectly benefit from this as it could affect their healthcare costs and access.
- Over 7 billion people rely on health systems globally, either directly as insured or as part of broader healthcare delivery systems.
- The findings of this study might influence future healthcare regulatory decisions that could potentially impact entire health systems.
Reasoning
- The budget constraint means only a limited part of the broader affected population can be directly influenced by the policy. The study and its outcomes have a budget potential to impact stakeholders like healthcare providers directly, while other impacts trickle to consumers indirectly.
- The goal of the policy is to address anti-competitive behavior that can inflate costs without adding value to patient care; thus, its primary direct impacts will be on insurers and healthcare providers.
- As this is a study and report generation by the Government Accountability Office, initial impacts on wellbeing are indirect for non-provider/insurer groups, manifesting potentially through future regulatory or industry-standard changes.
- Simulated interviews include profiles across a reasonable cross-section including direct and indirect stakeholders, ensuring coverage of different perspectives.
- Cost-benefit factors influence whether impact is 'low', 'medium', 'high', or 'none'. Individuals' direct economic connection to healthcare systems predicates their potential policy impact.
Simulated Interviews
Hospital Administrator (San Francisco, CA)
Age: 45 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- I believe addressing anti-competitive clauses can improve transparency and potentially reduce healthcare costs, which would be good for patients.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 8 | 6 |
Insurance Executive (Nashville, TN)
Age: 52 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- I expect this study might lead to more oversight and potentially limit our contract terms, possibly raising operational costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 5 | 6 |
| Year 5 | 5 | 6 |
| Year 10 | 5 | 6 |
| Year 20 | 4 | 6 |
Tech Consultant (New York, NY)
Age: 30 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 8/20
Statement of Opinion:
- If this leads to improved billing practices and lower costs, it would be beneficial for healthcare consumers like myself.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 6 | 5 |
Primary Care Physician (Seattle, WA)
Age: 60 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 5.0 years
Commonness: 3/20
Statement of Opinion:
- Reducing anti-competitive practices could help make healthcare more affordable and accessible, but there’s a concern about more bureaucracy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 7 | 8 |
| Year 20 | 7 | 7 |
Healthcare Policy Analyst (Phoenix, AZ)
Age: 35 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 2/20
Statement of Opinion:
- The results of this study will be crucial for future policy-making and can create a groundwork for fairer practices in healthcare.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Retired (Rural, KS)
Age: 70 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- My concern is about the affordability of care, and any potential changes that could alleviate hidden costs are welcomed.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Graduate Student (Chicago, IL)
Age: 25 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 6/20
Statement of Opinion:
- This policy highlights the evolution in healthcare systems towards fairness and transparency, which seems promising.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Small Business Owner (Miami, FL)
Age: 40 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- If this can lower insurance costs, it could greatly help my business and my employees.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
Healthcare Consultant (Las Vegas, NV)
Age: 55 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- It's essential that the findings are acted upon to truly benefit the healthcare system efficiency. More study won't help alone.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 7 | 7 |
Registered Nurse (Boston, MA)
Age: 28 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 15.0 years
Commonness: 5/20
Statement of Opinion:
- Any effort to remove these clauses could translate into less financial stress for patients, improving their mental health.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Cost Estimates
Year 1: $5000000 (Low: $3000000, High: $7000000)
Year 2: $0 (Low: $0, High: $0)
Year 3: $0 (Low: $0, High: $0)
Year 5: $0 (Low: $0, High: $0)
Year 10: $0 (Low: $0, High: $0)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- Focus on studying existing contract clauses, which doesn't involve physical or capital resources.
- Potential for long-term regulatory change informed by study results.
- Health insurers and providers may need to provide data or access that could result in increased transparency in the industry.