Healthy Competition for Better Care

Summary#

This bill would ban certain contract terms between group health plans or health insurance issuers and "covered entities" (providers, networks, third-party administrators, or other service providers that offer access to a provider network). The bill says plans and issuers may not enter agreements that, directly or indirectly, stop a plan from steering or directing enrollees to providers not in the agreement or from offering incentives to use specific providers. It also forbids agreements that force a plan or issuer to sign additional contracts with affiliates, set payment rates for affiliates not party to the agreement, or prevent other plans or issuers from paying a lower rate for services.

The bill adds these rules to three federal statutes: the Public Health Service Act (a new subsection), the Employee Retirement Income Security Act (ERISA section 724), and the Internal Revenue Code (section 9824). Each statute includes the same definition of "covered entity," the same set of prohibited terms, and the same exceptions for certain network designs. The bill allows exceptions for health maintenance organizations that operate through exclusive multi-specialty physician groups and for value-based network arrangements (for example, exclusive provider networks, accountable care organizations, centers of excellence, and similar arrangements). The bill says regulators should write rules within one year to implement the changes. The new rules would apply to contracts entered into, amended, or renewed 18 months after enactment.

What it means for you#

• If you have an employer or individual health plan, your plan could be able to direct or steer you to different providers or offer incentives, and provider contracts could not block that steering.
• If you get care from a provider or belong to a provider network, contracts with insurers could not include the specific restrictions the bill bans.
• The bill keeps exceptions for certain HMOs and for value-based network arrangements, so those network types can keep exclusive or aligned designs.

Expenses#

No publicly available information on estimated federal or private costs. The bill requires the Departments of Health and Human Services, Labor, and the Treasury to issue implementing regulations within one year of enactment.

Proponents' View#

Supporters say the bill would ban anticompetitive contract terms that limit access to higher-quality, lower-cost care and would protect plans' flexibility to design networks and offer incentives to enrollees.

Opponents' View#

No publicly available information on opponents' specific views in the bill text or metadata.