Markup of Fifteen Bills

yeah

and then i was like yeah that's that's a good idea like i remember when i was in high school i used to get a call from a friend who was like oh i don't know what's going on but i didn't know what was going on so i no no no no no no no no no no no no no no no yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah

so Subcommittee will come to order. The Ch- the Chairman recognizes himself for an opening statement. Today's mark-up will further our efforts to lower health care costs for all Americans and safeguard our communities. It builds off our most recent hearing that examines several policy proposals to increase price transparency across the health sector and builds on President Trump's initiatives to bring more transparency to our health system. The mark-up also builds on the work this subcommittee did in passing the Fentanyl Act led by myself and Mister Latta and the Support Act for Patients and Communities Reauthorization Act led by Chairman Guthrie, both of which President Trump signed into law last year. Health care costs remain one of the most important challenges facing American patients, families and employers. Today's health system can be complex and difficult to navigate, leaving many Americans without clear information about the cost or quality of care they receive. Patients are often asked to make important decisions without clear information about what the costs are that they might face, whether a provider is in-network, out-of-network, or what alternative treatment options might be available. Even those who carefully plan medical expenses can be surprised by bills that arrive weeks or months after receiving care. The current lack of transparency leaves patients in the dark and limits their ability to make informed care decisions. At a time when consolidation among insurers and providers continues to reduce competition and drive up prices, transparency serves as a potential solution to empower consumer choice, improve health care outcomes, and ultimately lower costs. That is why we need to continue to move these critical bills across the finish line. Understand we know there is more work that needs to be done to refine to refine many of these bills between the subcommittee action today But this is something that has been important to both sides of the aisle, and I look forward to continuing our work. One of the bills under consideration is the Lower Costs, More Transparency Act, which is a continuation of our transparency work from last Congress. The bill codifies many of the regulations implemented by the Trump administration and aims to bolster transparency and compliance. It does so by requiring hospitals and providers to publicly post prices for their services and it standardizes information for the these charges and services provided by these entities. Some of the other transparency bills in front of us today will bring more accountability and visibility into commercial and Medicare Advantage insurance plans. Several relate to prior authorization, so individuals can see the percentage of health claims approved or denied in a plan year. Another bill aims to bring transparency and premium dollar into premium dollars, which consumers better understand how plans are using their premium dollars. The medical loss ratio, or MLR, was created under the so under the so-called Affordable Care Act, and it is it it is the percentage of premium dollars spent by an insurance company on medical care outside of an of administrative costs or profits. As we heard in our health care affordability series hearings, there is a gaming of this accountability measure. Incorporating increased transparency into plans and premiums helps provide clarity as to where premium dollars are being spent by insurance companies and how much of it is actually going toward beneficiary care. Additionally, there are several bills under consideration that continue our efforts into the illicit drug space. One of the bills is the combating illicit xyloxine act, which would classify xyloxine as a schedule three under controlled substances act. while also protecting its legitimate use in large animal veterinary medicine. The bill is important to my district as accor- because according to the National Cattlemen's Association Virginia's ninth district is the largest cattle producing congressional district east of the Mississippi. And my district is physically home to two veterinary schools. Another important b- bill before us is Tyler's Law, which requires the Department of Health and Human Services or HHS to study and issue guidance on whether hospitals should implement fentanyl testing in routine emergency department drug screens. Lastly, we will consider a couple of bills involving community health centers, one of which is led by Vice Chairwoman Harshberger. That bill would allow for some community health center funding to be used for nutrition education and chronic disease prevention, initiatives. I look forward to continuing our work on these policies and advancing them to the full committee. I now recognize Ranking member DeGette for her five minutes for an opening statement. Ms. DeGette.

Thank you so much, Mr. Chairman. Uh, the legislation that we're marking up today has a wide range and, uh, frankly, is a long time coming, so I thank you. The bills include critical policies to bring transparency to our health care system, improve care at community health centers, and enhance the public health response to the ongoing opioid epidemic. This includes the Lower Costs, More Transparency Act, which we've been working to improve and which will help begin to untangle the thicket of healthcare pricing. It also includes legislation to make fentanyl test strips and opioid reversal medications more available, interventions that are proven to save lives. We're marking up my bill, the Medicare Advantage Cost Transparency Act, which will require Medicare Advantage plans to report just how much they pay for your care, and how much you pay for it, helping policymakers get a handle on just what people are getting from their MA plans, and I'm pleased that this has bipartisan support. Unfortunately though, we're also mark marking up a policy to criminalize a class of drugs, tossing out the the the possibility that they could have a medical use, and guaranteeing f- guaranteeing f- prison time for people co- possessing it. Furthermore, we're moving ahead with these bills kind of haphazardly, Seems like technical feedback from agencies and CBO scores are an afterthought, and we're rushing ahead, though I'm not aware of any deadline for these bills. Two of these bills will result in Americans being put in prison should they become law. And so I don't think we should rush it, and I don't think it's a good way to legislate. Um, once the Democrats have the gavel to this committee again, I guarantee we're not gonna legislate in just a haphazard way. Uh there's also a glaring omission in this market. Despite consensus from our witness panel on the importance of transparency and ownership of hospitals and physician practices, and frankly a growing awareness on the part of the entire health care community that we need more transparency, we're not marking up the bill that Representative Schakowsky and Bill Arrakes introduced last Congress, to provide exactly that. I know that private equity firms, which buy up some hospitals and physician practices, don't want consumers to know that their doctor's business or hospital is actually private equity owned. So what are they afraid of? And why and why is that opposition stymieing our committee's work to shine light in the American health care system? I say enough. We need to move this critical transparency legislation forward. so that policymakers can get a handle on the impact of private equity in hospitals and health care, and so the consumers can understand who owns the place where they get care. And I'm gonna offer an amendment later to force the issue, but I would think we would be able to do this on a bipartisan basis. I'm glad we're moving some of these policies forward, enshrining transparency requirements into law has been a long time in coming. So let's approach these issues fearlessly and deliberately. Um, and let's get this done. I yield back.

Jen Levy yields back now, recognizes the chairman of the first of the of the full committee, and it is the first in the importance of committees and is now in the committee.

It is first committee, exactly.

I recognize Mister Guthrie from Secretary.

Thank you, Mister Chairman, thank you for recognizing the first permanent committee, uh, in most historic. So I wanna thank you so much for uh to take a moment to recognize the great work that we as a committee have done not only to mitigate the threat of illicit drug flooding into United States, but also support our fellow Americans who are battling substance use disorder. With while I'm proud that both the Halt Vento Act and the Support Act were signed into law last year there's always much more that can be done, and we remain committed to a healthier and safer America. In this market, we'll consider a bill that reduce the threat of Xylazine and Nidazines. The bills before us today will help uh get threatening substances off our streets. as well as make our communities healthier and safer. Today we're considering several bills focused on enhancing transparency in healthcare. This includes legislation to build upon the Trump administration historic price transparency regulations and take action on the president's great healthcare plan. These bills will help provide the tools that consumers and employers need to make healthcare more affordable and increase competition across the market and build on the committee's many years of bipartisan work to improve transparency in healthcare. Our mark-up today will reinforce the committee's leadership on the issues as we continue working on these policies with colleagues across the aisle and other comi- and other house committees in the Senate to advance price transparency law into law. I want to thank my colleagues for being here, and I consider the legislation before us, and I yield back.

Gentleman yields back. Now recognize the ranking member of the full committee, Mister Palano, New Jersey, for his uh Opening statement.

Good, Mr. Chairman. Today the subcommittee will mark up fifteen bills, and some of these bills make transparency reforms that I will support, as I'm always willing to work on policies that advance the ball forward for consumer and patients, regardless of how small or incremental. However, I want to make clear to my Republican colleagues that these bills are not adequate to address the issue of healthcare affordability. The truth is, Republicans have created a healthcare affordability crisis with their big ugly bill that cut health care by a trillion dollars, the largest health care cut in American history, and by refusing to extend the a c a enhanced premium tax credit. Now across the country, Americans are seeing their health care costs double or even triple in one year. Hospitals are closing service lines and facilities due to the big ugly bill's hospital cuts. And while we're going to need to address this crisis, I am pleased we are considering the Lower Costs, More Transparency Act today. This bill represents the work this committee has undertaken for several congresses and that I led in the previous congress with former chair Rogers. And this legislation will empower consumers and employers with data on the prices hospitals charge and the rates insurers pay, so that they can compare prices and save money on healthcare services. I'm also pleased we're considering several bills that will improve transparency of the Medicare Advantage program. These bills bring much needed transparency to the MA program by requiring insurance companies to report data on supplemental benefits, spending on medical services, and broker compensation. They also improve transparency of prior authorization. However, I am disappointed that this mark-up does not include a provider ownership transparency bill. This bill would require transparency around ownership of hospitals and physician practices, including for entities owned by private equity and venture capital firms. Without transparent ownership data, healthcare consolidation will continue unchecked driving up costs for consumers and reducing access to care. And I believe uh we can't adhere or we can't achieve any true transparency in healthcare without ownership transparency. I'm also pleased for considering H R eight two O one, the expanding community access to health services act, which would require community health centers to offer behavioral health and substance use disorder services, and provide funding for centers that don't already offer those services. And finally, Mister Chairman, H R seven nine seven raised a serious concerns. As with similar bills, this committee is considering in the past to mandate class-wide scheduling of a class of substances. These bills would have Congress directly put substances into the schedule by statute by passing the eight factor scientific and medical review that the Controlled Substances Act normally requires before a substance is scheduled. Congress created this process for a reason. It draws on FTA and DEA's expertise, includes a public comment period and produces a reviewable record. These safeguards are designed to ensure that decisions with major consequences for medical research patient access and criminal liability rest on scientific evidence so I would urge the committee to withhold further action on this bill and simply direct DEI DOJ and HHS to do their jobs and engage in a science-based process to determine appropriate scheduling of these substances. But before I conclude Just wanna point out that a number of the bills being considered still have not received technical assistance from the agencies with expertise on these issues. So we received technical assistance on some of the other bills only a couple of days ago. So we also need more time to consider feedback from stakeholders on many of these bills. So I hope we can spend more time after this mark-up working on these bills before rushing to a full committee mark-up on policies that, in my opinion, need more work. But With that, I yield back the balance of my time. Thank you, Mister Chairman.

I thank the gentleman for yielding back and I would uh would agree with him uh that these bills need some more refinement before we go to full committee and so we're gonna continue to work on a number of issues. And with that, I now call uh oh, wait a minute, about to skip everybody else's right to do an opening statement. I remind members that pursuant to committee rules, all members' opening statements will be made a part of the record, or their further opening statements. Seeing none. I call up HR one two six six and ask the clerk to report.

HR twelve sixty six, a bill to prohibit certain uses of xylosine and for other purposes.

Without objection, the first reading of bill is dispensed with and the bill will be open for amendment at any point. So ordered. And I would now like to recognize myself to speak on uh HR twelve sixty six combating illicit xylosine act. I would like to offer my strong support for the act. uh, which places Xylazine into schedule three of the Controlled Substance Act, while ensuring there is exemption for appropriate use within the veterinary and ranching industry. Xylazine is a veterinary drug used to sedate large animals. It, it apparently does not have a legitimate use in humans. We'll have some discussion about that. Yet bad actors are using Xylazine by mixing it with fentanyl to make it far deadlier. It is critical that we pass a common sense, uh, bill that takes large strides to protect the American public while ensuring veterinary access to the drug. And I urge my colleagues to support the bill and now recognize the gentlelady from Colorado

I have an amendment.

w- who has an amendment at the desk.

Degett, underline O three nine.

Amendment to H R twelve sixty-six, offered by Miss Degett of Colorado. Page two, strike lines thirteen through nineteen, and insert the following. Section three, adding Xylazin to schedule five. Schedule five of section two O two C of the Controlled Substances Act, twenty one. USC eight twelve is amended. One, by striking any compound mixture or preparation and inserting A, any compound mixture or preparation, and two, by adding at the end of

Any objection to reading to awaiting the reading of the amendment? Seeing none. Amendment is before us. I recognize the gentlelady from Colorado, Ms. DeGette.

Thank you, Mr. Chairman. Mr. Chairman, I'm con concerned that this bill circumvents the DEA process for scheduling and that would arbitrarily schedule xylosine and schedule three with no scientific justification. Possession of a schedule three drug carries penalties up to ten years for a first offense.

OK.

Criminalization does not meaningfully deter drug use, and it's not the answer to our nation's substance abuse crisis. Congress should either insist that DEA and HHS produce an eight factor scientific analysis on xylosine, to inform a scheduling decision, going about it the right way, or to place Xylazine in schedule five,

Mm-hmm.

making it in a controlled substance, but but possession of which is a misdemeanor offense, not a felony. Uh, Mister Chairman, as you said, Xylazine is often used with fentanyl, but and and so clearly that's gonna be a felony sentence. But for Xylazine in and of itself, we need to have that analysis, which is always used if we're going to make something a schedule three controlled substance. Um, I'm told that the Biden administration did produce an analysis, but it's never been released, even though the ranking member Pilon requested such an analysis in a September four, twenty twenty four letter, and I'd ask unanimous consent to put that in the record.

Without objection, so we're

Advocates tell me advocates tell me that the analysis recommended placing xylosine in schedule but we're still waiting to see that. And and um so what my amendment would do is it would place xyloxine in schedule five, rather than schedule three, maintaining DEA's ability to track and prosecute misuse of xyloxine, while also protecting biomedical research and substance abuse treatment efforts. I suspect that it will also save federal money that would otherwise be wasted over criminalizing xyloxine, But we wouldn't know because we haven't yet seen a CBO score for this bill. Uh, but uh but in my experience, both when I was practicing law and also on this committee, if you over schedule a offense, it's just gonna cost a lot more and it's gonna put a lot more people in prison. Um, and so I just would hope to work with you, Mister Chairman, to get to a solution where we get the real expert analysis we need to make such a weighty decision that could have impact on people's lives, to look and see if we can get the eight factor analysis. And um and I would hope you could work with me on this, Mister Chairman.

I'm I'm more than happy to work with you and try to follow the science and figure out what's right. I agree I I am glad that we agree that it needs to be scheduled and that we need to put it at some level, uh but we'll see where where we go when we get the uh the analysis and look at all the science and data.

Great, thank you so much.

And I appreciate that.

In that case, I will withdraw the amendment based on on your assurance you'll work with me.

Gentlelady has uh agreed to withdraw her amendment. Any further amendments to uh HR twelve sixty six? Any further discussion on twelve sixty six? Recognized gentlelady from Washington, Doctor from Washington, Doctor Schreier.

Thank you, Mister Chairman. Uh, I'm glad that our subcommittee is considering the combating illicit silencing act. Uh, as a doctor, I look at the worsening synthetic drug crisis through a medical lens, and what we're seeing with the rise of uh xylazine or trank is incredibly alarming. This drug is devastating communities across the nation, and that includes my home state of Washington. Um, for decades, xylazine has had a safe and legitimate use in veterinary medicine to sedate large animals. Um, but recently illicit drug traffickers have been using it as a cheap cutting agent for fentanyl and because xyloxine is a sedative and not an opiate, standard overdose reversal agents like Narcan don't work against it. So this makes an already deadly fentanyl crisis even potentially more lethal and difficult to respond to and treat, which makes it a challenge for first responders. Um, it also causes horrible skin lesions and other uh has other impacts. Um, my district covers uh everything from suburban neighborhoods to agricultural communities and i know first hand that farmers ranchers and veterinarians really rely on xyloxine to safely handle injured or dangerous livestock and so you have this dilemma where on one hand non-physicians have a legitimate veterinary use for this while on the other hand bad actors are using xyloxine as a cutting agent for fentanyl and endangering people's lives and so Because of this, the drug can't really be effectively scheduled through DEA, and that means that we as a body have to act on this in order to regulate xylosine. I I'm proud to sponsor this legislation, which includes xylosine as a schedule three drug and allows it to still be administered for safe veterinary purposes. And I would encourage my encourage my colleagues to vote yes, and I yield back.

Jen Leibsbach, anyone else? Any further discussion? Recognize the gentleman from Florida, uh, Mr. Bill Rockus.

Thank you. Thank you, Mr. Chairman. I appreciate. Uh, I support, of course, uh, HR uh twelve sixty-six, the combating illicit xylitolin act legislation. I'm proud to co-lead alongside my colleagues, Representative Panetta, Pflueger, Pepper, Fitzgerald, Pappas Fitzgerald, and Ross. But either they were either co-sponsors as well, like the good doctor over here. Communities across our country continue to grapple with the devastating consequences of the illicit drug epidemic. As law enforcement and public health officials work to combat fi- uh fentanyl and other dangerous substances traffickers continue to adapt by introducing new and increasingly deadly addictives, uh additives in this case into illicit uh drug supply. One of those substances is xyloxine, a veterinary sedative that was never intended for human use. Drug traffickers have increasingly used xyloxine as a low-cost cutting agent and fentanyl, and other illicit drugs, creating mixtures that are more dangerous, more difficult to treat, and increasingly present in communities throughout the country, unfortunately. our laws must keep pace with these emerging threats, and that's what we're doing today. The combating illicit xylosine act would classify xylosine as a schedule three controlled substance, provide law enforcement with additional tools to track and combat its diversion into the illicit market and require further reporting and analysis regarding its uh prevalence and misuse. At the same time, This legislation protects the legitimate use of xylosine by veterinarians. We work with them and farmers as well, ranchers and others who rely on this medication to treat large animals. As drug traffickers continue to adapt and evolve, unfortunately, Congress must ensure that our laws and enforcement tools remain effective. So with that, uh, Mr. Chairman, I urge my colleagues to support this particular piece of legislation. And I yield back.

Gentlemen, the yield's back, any further discussion on the bill? Seeing none, the question now occurs on forwarding HR twelve sixty-six as uh f to the full committee. All those in favor say aye. Those no. The ayes have it. The bill is agreed to and forwarded to the full committee. And now call up HR two zero zero four and ask the clerk to report.

H R twenty O four. A bill to direct the secretary of health and human services to issue guidance on whether hospital emergency departments should be should implement fentanyl testing as a routine procedure for patients experiencing an overdose and for other purposes be it enact enacted

The the the gentleman uh without objection, the first reading of the bill is dispensed with and the bill will be open for amendment at any point. Seeing no objection, so ordered. I would like to offer my strong support for H R two zero zero four Tyler's law. This legislation directs HHS to conduct a study on the utilization costs and potential benefits of fentanyl testing in horse hospital emergency departments so often the bills that we have before us are because we've run across something in the real life world and this is one of those bills Tyler's name is is na- Tyler's law is named after Tyler Shamish a who suffered from a fatal fentanyl poisoning after doctors failed to test for phenyl when he was admitted to the hospital emergency room. This bill would help prevent this tragedy from occurring in the future by helping insure providers are able to apply the best practices when treating cases of potential drug overdose. I strongly urge my colleagues to support the bill, and I yield back. Does anyone else seek to be recognized to speak to the bill? I see none. So I vote no. Oh. Recognized as gentlelady from Colorado, ranking member of of the sub, Miss DeGette.

Thank you, Mister Chairman, fentanyl and its ultra potent analogs surpass prescription opioids as the leading cause of overdose death deaths a year ago or a decade ago, but our overdose prevention strategies just aren't keeping up. Recent years have seen great progress in point of care testing technology, meaning that we have long overdue life-saving tools to treat fentanyl overdose. tools that could have saved the life of nineteen year old tyler who died of an overdose despite going to the hospital because neither tyler nor his clinicians knew he had taken fentanyl. Despite uh diagnostic advancements and the rising prevalence of illicit fentanyl, only a handful of states require emergency departments to test as part of their uh toxicology screenings. This bill would give us more information about the feasibility regarding fentanyl testing in emergency departments nationwide and direct hhs to issue guides accordingly and so we all on this side urge support of this we support it strongly and we yield back I yield back

any further discussion on the bill seeing none question now occurs on forwarding hr two zero zero four to the full committee all those in favor say aye

so so long

aye those opposed no the ayes have it and the bill is agreed to and forwarded to the full committee Now call up H R seven nine seven zero. The clerk call up H R seven nine seven zero.

H R seventy nine seventy. To amend the Controlled Substances Act, to permanently schedule two benzalbenzamyelital uh opioids, uh as schedule one controlled substances and for other purposes.

Without objection, the first reading of the bill is dispensed with and the bill will be open for amendment at any point. Seeing no objection, that is so ordered. Uh, I'm gonna offer strong support for this bill as well, and urge all of my co- my colleagues to join me in the support of the policy. This is the Stop Nidazine's Act. This legislation enacts class-wide scheduling for Nidazine under schedule one. This is a synthetic opioid that is similar to, uh, but can exceed the potency of fentanyl. They are not approved for any medical use in the U. S. and are likely to be abused in the same manner as other schedule one Though many Nidazines have been placed under schedule one of the Controlled Substances Act and three have been placed under control internationally a class-wide scheduling is imperative to stem the flow of this dangerous substance. Chemical suppliers primarily located in China have been skirting the law by introducing new Nidazines or analogs when one becomes more difficult to produce due to regulations or scheduling. This legislation is critical is a critical step to tightening the controls we have on the class of NIDAZEEMs and working towards a safer America. You all remember this is what what they do is they change the formula just a little bit. We saw this with the analogs to fentanyl, and that way they can get around the law and it makes it a whole lot easier for them or to either skirt the law and get away with it, or to just bring it into the United States uh or elsewhere. So I strongly urge my colleagues to support this bill and I yield back and now recognize the gentleman from New Jersey Mr. Polon for his uh five minutes.

Uh thank you and I um speak in opposition to the bill. Mister Chairman uh let me start where I think every member of this subcommittee already agrees that Nidazine are or Nidazines I should say are dangerous. They're potent and Americans using it illicitly are suffering and dying. And what I'm concerned about is how this bill approaches the problem. What the agencies should be doing is engaging in the approach Congress laid out in the Controlled Substances Act. which requires scientific and regulatory entities to collaborate on a science-based approach to drug scheduling. But instead, HR seven nine seven zero would permanently place an entire chemical class, those that exist today and those not yet invented, into schedule one, and it would do so immediately. And I have three problems with this approach. First of all, this structure-based scheduling, this is structure-based scheduling, not science-based scheduling, For more than fifty years the the CSA has asked a basic question before a drug enters schedule one, and that is, does it actually have a high potential for abuse and no accepted medical use? And that answer has rested on an eight factor scientific and medical evaluation led by HHS and the FDA. But HR seven nine seven O sets that evaluation aside for an entire class. Public health experts have warned for years that this rests on an unproven assumption that structurally similar molecules behave similarly, but they do not always. Scheduling by structure alone risks sweeping in a potential anecdote alongside the poison. Now secondly, this bill has no off-ramp, and schedule one is where research is stopped. Once the substance is scheduled, there's no built-in mechanism to remove it if research later shows it's harmless or even useful. And schedule one is precisely the category that makes that research hardest to perform. The Government Accountability Office, reviewing the fentanyl class wide order, documented that scientists face real obstacles studying a schedule one drugs, including long delays in obtaining approval. And this warning is particularly significant for Nidazines, because CDC has found that Naloxone can reverse a Nidazine overdose, but of- often only after repeated doses. Designing better reversal protocols means studying these compounds, And that work uh would make this, I mean it's harder to do with this bill, not easier. And third, this approach is not new. The DEA already has the authority to schedule Nidazine compounds, and has been doing so on a temporary basis since twenty twenty. So each time we scheduled one compound, the illicit market answered with another more potent one. Nidazines themselves are partly a product of that dynamic, and the next move in a game of chemical whack-a-mole A broad nonpartisan coalition has told Congress this repeatedly, the Leadership Conference on Civil and Human Rights and its two hundred forty member organizations the Drug Policy Alliance the Vera Institute of Justice, the Sentencing Project, AIDS United, and law enforcement voices like the Law Enforcement Action Partnership. And their message is consistent, permanent class-wide scheduling repeats the failures of the drug war while diverting resources from what drove overdose deaths drowned down last year. Naloxone, fentanyl, test strips, and medications for opioid use disorder. So, just to be clear, schedule what the science directs us to schedule. Build in a research pathway and an off-ramp for substances later shown to be harmless, and pair any enforcement with the health investments championed by this committee. If we're serious about stopping nidazines, let's give scientists the tool to understand them, and not just give prosecutors the tools to charge them. So I urge my colleagues to oppose this bill as written, and I I reserve the balance of my time, Mister Chairman.

Gentleman yields back. Any further discussion on the bill? Okay. Seeing no further discussion on the bill, the bill comes up for a vote. All those in favor say aye. Aye. Opposed, no.

No. No.

The ayes have it. Um and the bill is forwarded to the full committee for consideration. All right. Now I call up H R fifteen sixty one and ask the clerk to report.

H R fifteen sixty one. A bill to require with respect to fentanyl and xylazine test strips to r- to authorize the use of grant funds for such test strips and for other purposes. be in an acted place.

Without objection, the first reading of the bill is dispensed with, and the bill will be open for amendment at any point. Seeing no objection, so ordered. Does anyone seek to be recognized on the bill? All right, nobody gave me a script on this one.

Chairman.

Gentlelady from Colorado.

Drug dealers often mix drugs with fentanyl to increase potency at low cost, which increases the likelihood of a fatal interaction. That's why testing unregulated drugs for fentanyl is a critical part of preventing overdoses. These tests are inexpensive, easy to use, and they give results within five minutes. Results can be the difference between life and death because many people who tragically overdose on fentanyl were not aware that they were taking fentanyl. It's critical that we train our public health professionals on the front lines, to carry and facilitate access to this lifesaving tool. The alert act expands an existing SAMSA program to just do that, provide fentanyl test strips training and resources to our nation's first responders, helping them save lives. I urge everybody to support this bill and I yield back.

Gentlelady yields back. Anyone else wishing to speak to the bill? Seeing none, the ch- the question now occurs on forwarding HR fifteen sixty one to the full committee. All those in favor say aye. Aye.

Aye.

All those opposed, no. The ayes have it and the bills agreed to and forwarded to the full committee. Now call up H H R seven nine zero four and ask the clerk to report.

Seven nine nine four.

S seven nine nine four, sorry, the handwriting was I read wrong.

H R seventy nine ninety four. A bill to establish a grant program to provide schools with opioid overdose reversal drugs, to direct schools receiving federal funds

Without objection, the first reading of the bill is dispensed with, and the bill will be open for amendment at any point. With the same objection, so ordered. Does anyone seek to be recognized on the bill?

Do I want

Recognized. Gentleman from California.

Yes, sir.

Good morning.

Thank you, Mister Chairman.

You're welcome.

Uh, and uh, Diana, thank you so much. H R seven nine nine four, the Helping Educators Respond to Overdoses Act is practical legislation that will save kids' lives. The HERO Act establishes a grant program for schools to purchase opioid overdose reversal drugs, making these lifesaving medications accessible in schools in case, God forbid, a student needs them. It also establishes grants to provide critical training for staff and implement educational resources for students and communities to help combat the opioid epidemic. According to UCLA Health, an average of twenty-two adolescents, ages fourteen to eighteen, died every week in the US in twenty twenty-two from drug overdoses. The equivalent of uh in some areas a full high school classroom each week, bringing the death rate to five point two per one hundred thousand. This is a public health crisis. We need to take action. And as an emergency medicine physician, I have cared for many patients overdosing on opioids. I've also had to comfort family members of patients who unfortunately were not able to receive lifesaving Narcan in time. Every story that ends in an overdose is tragic, but it cuts that much deeper when it could have been prevented, had lifesaving Narcan been available. We need to take action now to mitigate overdoses through training, education, and awareness. And we need to ensure wide-spread access to opioid overdose reversal medications like Nalaxone or Narcan. These medications exist, but they only work if they are accessible. That is why I introduced the HERO Act. I would like to thank the Chairman for including this important bill for consideration today, and I urge my colleagues to

Gentlemen yields back. Does anyone else wish to speak on H R seven nine nine four? Seeing none, the question now occurs on forwarding H R seven nine nine four to the full committee. All those in favor say aye.

Aye. Aye.

Those opposed no. The ayes have it and the bill is agreed to and forwarded to the full committee. And now we will call up HR nine three eight nine and ask the clerk to report.

H R ninety three eighty nine. A bill to amend the Public Health Service Act to authorize funding for nutrition, education, and chronic disease prevention at federally qualified health centers and for other purposes. Be it enacted by the House and the U

Whoops. Without objection, the first reading of the bill is dispensed with, and the bill will be opened for amendment at any point. Seeing no objection, so ordered. Does anyone seek to be recognized on the bill? Recognize the gentlelady, the Vice Chair of the subcommittee, Ms. Harshbarger from Tennessee.

Thank you, Mister Chairman, um, I'm proud to speak in support of my legislation, H. R. nine three eight nine, the Nutrition Education and Chronic Disease Prevention and Community Health Centers Act. As a pharmacist for almost forty years in East Tennessee, I saw firsthand the devastating toll that chronic diseases like diabetes, heart disease, obesity, and hypertension takes on patients, families and communities. And too often I was filling prescriptions for conditions that might have been prevented uh or at least better managed if patients had received the right education and support earlier. That's especially true in rural America. Many of the communities I represent face significant health care access challenges and patients may have to travel long distances to see a specialist. And in many areas, the community health center is the most accessible source primary care. These centers are often the front door to our health care system for working families, rural residents and underserved populations. Uh, community health centers already provide high quality cost effective care to millions of Americans, but they cannot solve our chronic disease crisis without the tools and resources to address one of the root causes which is poor nutrition. My legislation helps bridge this gap. This legislation would evidence-based nutrition counseling within community health centers. It would strengthen provider training in nutrition science, encourage team-based care models that include registered dietitians and community health workers and prioritize centers serving communities with high rates of food insecurity and diet-related disease. This legislation also builds upon the trusted infrastructure that community health centers already have established in communities across the country. Rather than creating a new federal program, it strengthens the existing providers that patients already know and trust. This effort aligns with the growing bipartisan recognition that we cannot simply spend more treating chronic disease after it occurs. We must do a better job preventing it in the first place. So every dollar invested in prevention has the potential to save far more in avoidable hospitalizations emergency room visits and long-term health care costs and more importantly it can help Americans live healthier, longer and more productive lives. I've always believed that the best prescription is the one you never have to write or fill. This helps uh this bill helps empower those community health care centers to deliver that kind of preventive care, and move us toward a health care system that focuses not only on treating illness, but on preventing it, and I appreciate the committee's consideration of these legislations, and I urge my colleagues to support its adoption. And I yield back.

Jen Leibold's back. Anyone else wish to discuss? Mr. Guetta of Colorado.

Thank you, that's uh, Mister Chairman, as we established in our public hear health hearing earlier this year, nutrition is truly a part of overall health. Nutrition education seamlessly integrates into primary care, Yes, in particular, yes. complementing routine evaluation and management of chronic conditions. Yes, yes, yes. This education could not be more important than Yes. for the disproportionately food insecure population. Yes, yes. that community health centers serve. These patients don't always live near a grocery store. They may have limited access to affordable fresh foods, and many rely on food banks to feed themselves and their families. We heard in April from our community health witness, Doctor Ulmer, about health center's innovative approaches to connecting patients with healthy food including food insecurity screenings medically tailored meals and onsite food pantry visits. Um, and I I've got to say in Denver, Colorado, my congressional district, we have a number of community health centers and we have some very innovative food banks in those centers. Um, there is a drawback of this bill, though, in that it expects more from health centers while failing to provide additional resources. And these health centers are spread awfully thin. I'm gonna support this bill, but I know um that my colleagues will want to work with me to make sure that we properly resource those health centers to be able to bri provide the health care and the nutrition. And with that, I yield back.

Jen The lady yields back. Any further discussion? Anyone on this side? Anybody over here? Seeing no further discussion on the bill, the question now occurs on forwarding H R nine three eight nine to the full committee. All those in favor say aye. Aye. Those opposed, no. The ayes have it, and the bill is agreed to and forwarded to the full committee. Now I ask the clerk to call up H two zero one.

H R eighty-two O one. A bill to amend the Public Health Service Act to require community health centers to provide behavioral and mental mental health and substance use disorder services, and for other purposes.

Without objection, the first reading of the bill is dispensed with, and the bill will be open for amendment at any point. Seeing no objections, so ordered. Is there anyone who wishes to speak to the bill? Recognized gentlelady from Colorado, Ms. DeGette.

Thank you very much, Mister Chairman, I I really want to commend our colleague Representative Lee from Nevada for bringing this bill up and I want to thank you for putting it on the agenda today. Low income adults and people covered by Medicaid are more likely to have behavioral health conditions, and more likely to get their health care at community health centers than are high income adults or those with private insurance. To address this immense need, community health centers have become leaders in integrating behavioral, mental health, and substance use disorder services into primary care.

That's good.

They provide school-based therapy to students, offer addiction recovery services including medication assisted treatment, and coordinate care for individuals who need intense case management. Health centers are increasingly spending more time on these services, but they don't have the resources necessary to meet in growing demands. A recent HRSA s estimate found that seven point seven million health center patients still need mental health services, and five point two million still need substance abuse disorder treatment. And as I mentioned earlier, I see this right in my urban congressional district of Denver, Colorado, where the community health centers are struggling to provide all these services. By authorizing additional funding, this bill will help close that gap and allow health centers to build capacity for comprehensive primary care for all. I urge support and I yield back.

Gentlelady yields back. Any further discussion? Seeing no further disquestion discussion. What?

Wait, Mr. Carter.

What? We're moving through like a steam train.

Okay, you go.

All right. All right. We'll keep rolling. The question now occurs on forwarding HR eight two zero one to the full committee. All those in favor say aye.

Aye.

Those opposed, no. The ayes have it and the bill is agreed to and forwarded to the full committee. I would now ask the clerk to call up H R nine three nine three.

H R ninety three ninety three. A bill to prom- promote price transparency in the healthcare sector.

Without objection, the first reading of the bill is dispensed with and the bill will be open for amendment at any point. Seeing no objection, so ordered, and now recognized, the gentleman from Kentucky, the chairman of the full committee for his five minutes on this. Is that right?

I see.

Speaking on the bill.

Thank you, mister.

Gentleman has the floor.

Thank you, mister chairman. Uh, the committee is considered H R nine three nine three. Uh, the Lower Costs More Transparency Act of twenty twenty six. I'm proud to introduce this legislation with my good friend, Ranking Member Pallone from New Jersey. The Lower Costs More Transparency Act builds on years of bipartisan work in this

Yes.

committee and across Congress to codify and build on the Trump administration's historic historic price transparency regulations. The legislation requires hospitals and health insurers and other sites of care to be transparent with the costs they charge the American people with the ultimate goal of equipping consumers and employers with the information they need to lower their health care costs. For years, the Energy and Commerce Committee has led the charge on efforts to bring greater transparency to health care. While these efforts did not get over the final finish line last Congress, this subcommittee mark-up is an important next step in our process to advance these policies. We know there is more work to do, but it is critical that we keep moving forward and make sure that we get something done on this common sense issue. I look forward to working with my ranking member, Pilon, as all of my colleagues on this subcommittee and committee, as we move to get across the aisle and into the Senate and get this information and this legislation to the President's desk for signature. I yield back.

Chairman, yields back now recognize the ranking member of the full committee, Mister Pilon of New Jersey for his uh

Thank you, Mr. Chairman. Uh, I'm speaking in support of the bill, the the bill, the lower cost, more transparency act brings much needed transparency to our nation's health system and represents the work that this committee has undertaken for several congresses. American families are currently facing a health care affordability crisis. Almost fifty percent of Americans report difficulty affording health care. Then more than forty percent of adults say they have either delayed or foregone medical care because of high costs. And prices for health care services also vary widely, and too often patients are forced to wait until after they've received care and have the medical bill to fully understand how much they owe. I think it's unacceptable that some consumers still cannot obtain price information in advance from their provider. What's more, the information can be misleading or inaccurate, making it difficult for consumers to compare prices across health care providers before receiving care. And the lack of transparency into healthcare prices makes it difficult for consumers to make informed decisions, and it also makes it challenging for employers to negotiate more competitive prices. So the Lower Costs, More Transparency Act codifies the existing requirements for both hospitals and insurers, to make public price information and strengthens the existing regulatory requirements. It will improve the accessibility and usability of the price information, by requiring hospitals and insurers to display the information standardized format. The legislation also strengthens agency enforcement and increases the penalty for hospitals found to be non-compliant. And lastly, the bill requires labs, ambulatory surgical centers, and imaging centers to display their cash prices. So Americans deserve greater transparency in the prices they pay for health care. The bill will empower consumers and employers with data on the prices hospitals charge, and the rates insurers pay. uh so they can compare prices and save money. I wanna say that I hope that we can continue to strengthen this bill and incorporate stakeholders' feedback, as I do believe that we have not had adequate time between our legislative hearing and now to do so, so I urge my colleagues to join me in supporting hr three nine, I'm sorry,

Yeah.

nine three nine three to bring much needed transparency to our health system. And I thank uh chairman Guthrie obviously, we worked together on this a long time. Thank you. Thank you, Chairman Griffin.

Thank you. The gentleman yields back. Any further discussion?

Yes, sir.

Recognize the gentleman from Michigan, Mister James.

Thank you. Uh, first of all, let me start off by saying I'm gonna support this transparency package. There's a lot of good stuff in it, but it doesn't go far enough. The ranking member just said he looks forward to strengthening it. Well, I have a great idea. Why don't we go with something we already have? Why don't we go with something that's already bipartisan, already bicameral, and something the ranking member himself put his name to last Congress? Why don't we go with that? Why don't we go with something that not a single person has stood up against on its merits? Why don't we go with the patient-served price tags? It is simple. It requires hospitals to clearly label their prices and make them easy to understand, easy to find, and it's gonna allow patients to save money by comparing prices and choosing the lowest cost options like we do in every other industry across the country, for every place and every corner. But we're not doing it here. No. Know why? Because some people don't wanna give other people the win in an election year. That's utter bull crap. And if you think I'm full of it, then prove me wrong. Vote for my amendment when I put it up next week. Patience deserve price tags, not games, not lip service. If you truly intend to give patients what they deserve, American citizens what they've earned, then put your money where your mouth is, Republicans and Democrats. And so I know the excuses. We didn't have enough time to see what was in the bill. We we didn't have enough time to review it. Okay. I'm putting everybody on notice right now, both sides. Next week. This is gonna be an amendment to this process. And if you're concerned with whose name's on the bill, great. The reason I'm putting on our amendment is to take my name off of it. I am not important. The American people are important. And so if there's any issue with my name being on this bill, then disregard it. I'll take it off. I'll put the ranking member's name on it. I'll put the chairman's name on it. This is something the chairman supports, something the ranking member helped write. Two members of the subcommittee co-sponsored, has bipartisan bicameral support. This is the type of thing the American people demand and expect. But we are failing in that duty because we're playing games. I'm sick of it. Hospitals wanna keep the pricing nebulous so that you can't compare prices. And we are playing along with them in our failure to look past our partisan differences and execute for the American people. My bill, the patients deserve price tax bill, is stronger than the uh than the uh the the current bill that's currently under consideration. You can compare it on its merits. And so now you can get the bill, read it. You have my personal cell phone number, the members on this committee. If you don't have time to read it, have your staff reach out to me. I will set up a Zoom and I will read it to them. It's not that long. I'm putting everybody on this committee on notice. This amendment will come up again. Well, thank you for listening. I'm taking your excuses away, Republicans and Democrats. This is serious. It's for our country. Stop the lip service. With that, I yield.

The gentleman yields back. We need further discussion. Gentleman from Ohio, Mister Lansman, is recognized.

Uh, thank you, Mister Chair. I have amendment at the desk.

Amendment at the desk, clerk will report.

Ninety nine, zero ninety nine.

Amendment to HR ninety three ninety three offered by Mister Lansman of Ohio. Page three, line twenty three, insert from a senior official uh after at the station. Page twenty four, line thirteen, insta insert from a senior official after attestation.

The amendment has been heard. Gentleman from Ohio is recognized to explain his amendment.

Uh, thank you, Mister Chair. This uh bill is a good bill in terms of us taking some steps to create further price transparency. Uh, at our hospitals, people, when they go to the hospital, uh, the last thing they need to worry about is uh not knowing how much each of the things that they're gonna be charged for cost. And there have been some attempts to, to do this in the past where we've said, look, we wanna know what the prices are. You gotta, you gotta, uh, display, make sure that your, uh, the folks that come to your hospital know how much everything costs. And what has happened is, uh, in many instances the data is provided, but in a way that nobody really understands. You can't really use. And so it's not like when you go to the hospital, somebody hands you all of the information in the most usable, uh, digestible, understandable way possible. In fact, it's the opposite. Oftentimes, uh, hospitals will comply with these laws by just providing an Excel spreadsheet. It's super complicated. It doesn't really help us get to what we're we're trying to achieve here, which is making sure that people know exactly how much everything is, uh, that they're being charged, everything. And so, especially on the front-end. uh before uh uh uh decisions are made. So the amendment says look let's go ahead and pass this bill but tack on to the bill language that says somebody has to be accountable for ensuring that the data uh is transparent that it's accurate and that we understand it somebody has to be accountable somebody at the hospital whether that's the CEO CFO or somebody at the senior level that's making these decisions they have to be held accountable Uh, that will make it more likely, uh, that what gets, uh, provided to, uh, folks that go to the hospital is real, uh, real information, information that will help them determine whether or not, uh, they need that procedure or, uh, whether or not they can afford, uh, what's being, uh, offered. So, uh, that's the amendment and I appreciate the chair and the ranking member, everyone's, uh, willingness to continue to work on this. This is hopefully gonna come out of the Senate too. uh and we'll have multiple opportunities to improve this, this is one of the changes that I think we should make, uh to ensure that whatever gets passed here gets implemented in a way where people have clear a clear understanding as to what is being uh what they're gonna get charged uh for and that there's there's total price transparency and that it's understandable so um I hope to continue to work with my colleagues on this issue, and while we don't

Uh, the gentleman yields back and

Thank you.

if I heard correctly, you withdrew the amendment. And I appreciate it. We'll go from there. Now recognize uh anybody on this end? I gotta look down here first. Mister Carter,

Okay.

Georgia, you're now ready.

Mister Chairman, I have an amendment at the desk.

Gentleman has an amendment at the desk. Clerk will report.

Amendment to H R ninety-three ninety-three, offered by Mister Carter of Georgia. At the end of the bill, add the following. Check section seven, improving health care coverage under vision's plans. A, in general, title twenty-seven of the Public Health Service Act is amended by inserting after section Uh, twenty-seven, nineteen A, the following new section. Section twenty-seven, nineteen B, improving coverage under vision plans. A, in general, with respect to a group health plan or individual or health group insurance coverage that provides benefits for items and services relating to vision care, uh, the following shall apply. One, duration of limited scope vision plans in the case of a doctor of optometry.

There will be a waiver of the reading of the amendment, without objection. So ordered. gentleman from george is recognized to explain his amendment

thank you mister chairman mister chairman i'm proud to offer this amendment alongside representative vet clark of new york the amendment features two key pieces of our legislation the dock access act that are broadly supported on a bipartisan basis aimed to boost transparency in the vision benefits market and help lower cost for eye and vision care consumers right now the vision benefits ma- market is largely dominated two vertically integrated vision benefit managers that provide vision insurance coverage to nearly two hundred million Americans. These two VBMs, notice I said V as in vision and not P as in pharmacy, although I I it is eerie that these are so similar. These two VBMs are not only the overwhelming provider of vision benefits in America but they also manufacture and sell nearly all eyeglass frames and lens on the market, nearly all of it made in China. They also own thousands of retail optical locations around the country. They own nearly all optical laboratories that produce finished prescription eyewear and they are aggressively acquiring independent eye care practices, nationwide at an astonishing rate. These two dominant VBMs have successively consolidated the coverage market, and now they have their sights set on dominating every other aspect of vision care in America. Did y'all catch that? Sight set on? Just wanna make sure. Okay. Um, they use this market dominance to keep prices high, to limit consumer choices, to dictate care, and to force doctors and patients to buy the products they make and use the services they own and operate. Our amendment aims to confront these abuses and it's time for this committee to act. This amendment is focused on shining a light and preventing VPNs from using their market power to steer patients toward affiliated providers and products. Right now, these VPMs force patients to use optical laboratories that are owned or under the direct control of their VPM. This amendment would prevent VPMs from mandating use of one of their subsidiary di businesses, their optical lab. Patients would still have the choice to use the VPM lab if that is what they wanted, but their amendment would g- also give them the freedom to choose another lab that worked best for them based on cost quality and convenience. Without this fix, patients will continue to face higher costs, inferior products and production, and unnecessarily long wait times for a finished pair of prescription eyeglasses. While we've been working on this issue for years, states like Georgia, New York, Kentucky, New Jersey, Illinois, Louisiana, Colorado, Texas, and dozens of others are passing tough new laws to address a wide range of BPM abuses. Congress has a responsibility to act as well, particularly because millions of Americans receive vision coverage through federally regulated plans that fall outside the reach of many state protections. Just a few weeks ago, the Government Accountability Office released a report requested by Chairman Guthrie that highlighted the extraordinary concentration that exists in the vision benefits marketplace and the challenges it poses for consumers, independent providers, and all of our communities. Consumer advocates and patient organizations are demanding reform. Groups such as Patients Rising and National Consumers League have called for greater scrutiny of VPMs and stronger protection for patients, including those found in our amendment. Their message is clear. Patients and consumers deserve transparency, competition, choice, and greater affordability. We cannot continue to ignore one of the most concentrated and least transparent segments of the healthcare system. By pulling back the curtain on costly controlling and care limiting VPM practices, we can help millions of Americans access more affordable vision care, preserve independent providers and ensure that patients, not corporate middlemen, remain at the center of important health care decisions. Thank you, Mister Chairman, I look forward to continuing to work with you and my colleagues on both sides of the aisle to advance meaningful VPM reforms and I yield back to you.

Would gentlemen would gentlemen yield? Gentlemen yield?

Uh, yes, I yield to the gentlemen.

I I just wanna say to what your your discussion, which uh that was my GIA request and report and and agree with the policy issues we have to address in your bill. with Mister Landsman's amendment as well and with Mister James, obviously very passionate about, uh, as we all are. And as we do the subcommittee process, the subcommittee mark-up, full committee mark-up, as you know, we're running out of legis legislative days, so we began this bill with the area which we all agree upon, which passed this committee, passed the House, and was uh taken out in the Senate on the lower cost more transparency. So the opportunities to improve this bill, that's what the process is, is from now until we get to the to the full committee mark-up and then beyond as we move forward. So so thanks for everybody offering really good ideas. Thanks for drawing your amendments and we can get to work between now and next if it's next week or when we have our our uh our full mark-up we'll be ready to to hopefully incorporate as much of this where it fits and what we can into this bill. So thanks everybody for their work.

Good.

I yield back to my friend from Georgia.

Yield back.

Gentleman yields back. Any further discussion on the amendment?

Mr. Chairman, I'm I'm gonna pull the amendment.

Gentleman ha uh has been recognized and wishes to withdraw his amendment without objection. So ordered. Any further amendments? Recognize the gentlelady from Colorado for

Thank you, Mr. Chairman,

the rest of the amendment.

I have an amendment at the desk to get underline O forty underline XML.

And the clerk will report it.

Amendment to H R ninety-three ninety-three, offered by Ms. DeGette of Colorado. Add at the end of section two the following new subsection. C, mandatory reporting with respect

Wave wave the reading, without objection, wave the reading of the uh amendment and recognize uh Ms. DeGette for her five minutes to explain her amendment.

Thank you so much, Mister Chairman, it's incredible to me that of all the bills from our transparency hearing to leave out of this mark-up, we are not including the ownership transparency legislation that's been championed by our colleagues, Miss Schakowsky and Mister Bill Arrakes, a bipartisan co-sponsorship. All four of our witnesses at the hearing agreed on the importance of this policy. The witness from the conservative American Enterprise Institute said the persistent challenge of insuring competitive health care markets, quote, has become more challenging due to to recent evolutions in ownership structures and the nature of consolidation. Amid, uh, end quote, amid the rise of private equity purchasers and both vertical and horizontal consolidation across health care sectors, business structures are becoming more opaque, convoluted, and tough to capture through existing reporting mechanisms. Addressing this lack of transparency is the absolute bare minimum Congress can do to begin tackling the problem of consolidation. So that's why I'm offering an amendment to add ownership transparency to this bill. What the amendment does is simply require reporting of certain health care entities, organizational structures, which I expect will help us understand how different ownership structures underpin consolidation and drive costs in the system. This amendment will set the table for better understanding just who owns hospitals and practices in our communities and just how different ownership arrangements affect cost in patient care. My amendment is substantially identical with just some technical changes to the bill that miss schakowsky and mr. bill iraqis introduced last congress twelve of the republicans and ten of the democrats on this subcommittee cosponsored legislation last congress the patient act that controlled this policy and and i think this is what uh chairman guthrie was just talking about is some of these things that need to be included in the bill as we move along and so I would just ask you, Mister Chairman, again, will you work with us to address any objections and and to work on the drafting so that we can include this policy in our bill as it comes forward in the full committee?

And I I appreciate the uh gentle lady's question and understand the intent of her amendment and the concept. The mark-up, this mark-up is an important next step in our committee's legislative process to advance these policies. We know there is more work to get some of these policies into a bipartisan place. And we look forward to continuing to work with you, ahead of the full committee mark-up. It is critical that we keep moving forward and make sure we get something done on this common sense issue.

Thank you, Mister Chair,

Appreciate it.

based on those assurances, I will withdraw the amendment.

Gentlelady withdraws her amendment. Any further amendments before the subcommittee?

I don't I don't have an amendment, but I wanna speak on the underlying bill.

Speaking on the underlying bill, the gentlelady from California is recognized for her five minutes. Ms. Barragan.

Uh, thank you, Mister Chairman. I I think it's important, um, that we work toward as much transparency as we can get. Um, we hear Americans tell us over and over again that the cost of health care is too high, and it's only getting more out of control. And when they go to the hospital, they often don't know how much a visit or a procedure will cost beforehand. And then they're left with high out-of-pocket costs and even serious medical debt. Health care is one of the only markets in this country where consumers don't know the price of a service until They receive a bill after the service was provided. This just happened to me. Uh, I was sent to GW and showed up. I was actually told if I paid in advance, I would get a discount, and I was given an amount. So I paid that amount. Well, guess what? I went home and I got a bill. I still got a bill. And I'm not the only one. Lauren in Colorado, she was T boned by another driver on her way to work. So she needed ankle surgery and an overnight stay. She was billed sixty- four thousand dollars by the hospital, and the bill did not clearly explain what services were charged, and what was covered by her insurance. In the end, the hospital admitted they had prematurely and mistakenly sent Lauren a bill before working out the balance with her insurer. After appealing the denied claims, and months of back and forth with both her insurer and the hospital, Lauren only owed a two hundred and fifty dollar copay. These are the types of problems Americans face all the time, because our health care system is too confusing, and consolidated, and not everyone has the time or the knowledge to understand complicated bills, and appeal claim denials. Increasing transparency is an important step to help us, whether that be consumers, employers, or lawmakers, see what is going on behind the scenes and make decisions based on the full picture. We should require health providers to provide patients a complete explanation of how much their health care costs, including how much the insurer covers and how much the patient is responsible for in a way that's clear and a way that's understandable. Health care providers should be required to provide detailed itemized bills to patients before they seek payment and try to collect debt. And providers should be required to publicly post their prices in dollars and cents so that patients aren't blind-sighted and have more meaningful choice. We need more information on who who n owns what in the health care system, so we can figure out if health insurance plans or health care providers are trying to hide certain business practices to maximize their own profits. So as we move this bill to full committee, I'm glad to hear that more work needs to be done. I urge my colleagues to build on this bill and to make it stronger. We can do that with stronger transparency and accountability, so we can get more meaningful information for our constituents. I asked the committee to add requirements for itemized bills from providers, that they add codifying explanation of benefits that include codes so people know what procedure they had as well as accountability requirements for middlemen in the healthcare system I know there's work being done on the senate side on a bipartisan basis that has some good language so I don't want to get partisan, but at the end of the day, this is about consumers, this is about making sure there is strong transparency. Patients and employers deserve clear, accessible information so that they have the power to explore their options and make informed decisions and save money. And with that, um, I yield back.

Generally yields back. Anyone else wishing to discuss the underlying bill or to make an amendment? Seeing none, the question now occurs on forwarding H R nine three nine three to the full committee. All those in favor say aye.

Aye.

Opposed, no. The ayes have and the bills agreed to and forward to the full committee. Now call would ask the clerk to call up H R nine three nine seven and ask the clerk to report.

H R ninety three ninety seven. A bill to amend title s twenty seven of the Public Health Service Act and title eighteen of the Social Security Act to ensure health insurer accountability through publishing of overhead costs and claim payments and to direct the Secretary of Health and Human Services to issue guidance on the provision of certain info- insurance information.

Without objection, the first reading of the bill is dispensed with and the bill will be open for amendment at any point. Seeing no objection, so ordered. Anyone wish to speak on the bill? Recognize the gentlelady from Tennessee, the Vice Chair of the subcommittee, Ms. Harshbarger, for her five minutes.

Thank you, Mr. Chairman. Speaking on transparency, I'd like to offer my support for HR nine three nine seven, the premium transparency act, and the legislation is introduced by Congressman Flueber Flueger from Texas. The Premium Transparency Act will enhance transparency and cost by requiring insurance companies to publicly post the percentage of insurance premiums that go toward health care overhead and profit and providing this information to consumers will hold insurers accountable for how patients' premium dollars are spent this will provide another tool for consumers to use as they stop uh, as they shop for plans, whether for seniors considering Medicare Advantage plans or in the commercial market. The bill also requires the Secretary of Health and Human Services to issue guidance to MA plans and uh commercial health plans on providing information on certain benefits and coverage under the plan in a standardized plain English format. Because the most concerning thing for people, and they would come to me all the time, you have to triage this because they don't understand, all the uh complicated uh insurers speak when they're trying to decide what plan to purchase. And this will help insure consumers understand the insurance that they may be enrolling in and can make the most informed cost-effective decisions for themselves and their families. I urge my colleagues to support this legislation advancing from the subcommittee today and look forward to continuing to work on this legislation ahead of the full committee mark-up. With that, I yield back.

The general lady yields back. Anyone else wishing to discuss the bill? Recognized?

This bill requires commercial insurers to disclose how much they spend on patient care versus overhead and profit. Good news. We already passed this when the Democrats passed medical loss ratio standards in the ACA. That's right. This bill's disclosure requirements are already the law of the land. So I'm so glad to see my Republican colleagues are finally coming around to some of these provisions in the a c a and i'm happy to support this bill even though it seems duplicative and i yield back

Jenner yields back, anyone else wishing to speak to the bill i'll recognize myself for five minutes uh and and i would just say to my uh friend and colleague from colorado um the the intent was great unfortunately some of the companies might be uh gaming the system by purchasing uh suppliers of health care, even though they're an insurance company, and then perhaps paying their own suppliers of certain health care more than they pay uh other suppliers of health care. And so this is a small step, but hopefully w- at some point we can get it so that everybody can see where all the money's going, so we can make sure it does go. The intent was absolutely right in the original ACA, uh, so I grant you on that one, I give you that point. Uh, but I think we have to keep working on it.

Like I Like I say, welcome to the party, Mister Chairman.

Thank you, madam. And I now uh yield back. And is there anyone else who wishes to get into the fun and discuss the underlying bill? Seeing none, the question now occurs on forwarding HR th nine three nine seven to the full committee. All those in favor say aye.

Aye.

Opposed, no. The ayes have it. The bill is agreed to and forwarded to the full committee. We will now call up HR nine three nine six. And ask the clerk to report.

H R ninety three ninety six. A bill to amend title twenty seven of the Public Health Service Act, the Employee Retirement Income Security Act of nineteen seventy-four, and the Internal Revenue Code of nineteen eighty-six, to require the displaying of claim denial rates.

And without objection, the first reading of the bill is dispensed with, and the bill will be open for amendment at any point. Seeing no objection, so ordered. I would like to recognize myself and I would like to uh offer my support for H R nine three the Prior Authorization Accountability Act. This legislation was introduced by Congressman Goldman from Texas. The Prior Authorization Accountability Act will require commercial health plans to be transparent with consumers about the prior authorization practices they employ in their plan. The bill would require plans to post information about which items and services are subject to prior authorization, as well as information about the percentage of requests that were approved or denied during a plan year. This information will be posted publicly so consumers know what prior authorization will look like in the plan they may enroll in. We've heard frustrations with prior authorization practices throughout our affordability hearing series, and this bill will help give consumers the tools they need to navigate the healthcare market when they're shopping for plans. Now, that's the script that sounds really good, and let me, but I wanna explain it in more common language if I might. What this means is when you go to renew your insurance next year, or uh or your uh uh plan, you can see if your plan is doing a whole lot of preauthorizations and denying a large number. And with that information, you can see if plan A is denying sixty percent of the preauthorizations and plan B is only denying ten percent, you might want to get plan B. you might wanna spend a dollar or two extra. It might be a it might be a little bit cheaper, but you're more likely to get better health care. So this is just to help the consumers figure it out. It's not that complicated of a bill, but it's a good bill. And I urge my colleagues to support this legislation, advancing from the subcommittee today, and look forward to continuing to work on this legislation ahead of the full committee mark-up. With that, I yield back and recognize the gentlelady of Colorado, Ms. DeGette, the ranking member of this sub the ranking member of this subcommittee for her five minutes on the issue.

Thank you, Mr. Chairman. You're exactly right. insurers use prior authorization to reduce their likelihood of paying for unnecessary medical expenses but on the along the way what they do is they delay or even deny patients essential care and they bury providers under the burdensome administrative back and forth all of us have calls every week in our congressional offices from our constituents who are uh are in limbo what

Mm-hmm.

while they need essential health care services from the prior authorization, and it's shameful.

Okay.

To address this issue, policymakers, researchers and patients alike need to have a clear view of the problem. This bill requires insurers to display certain prior authorization information, including the rate of denials, the the rate of those denials successfully appealed, and the average amount of time required per prior authorization determination. They say sunlight's the best disinfectant, so public disclosure of this information may force bad actors to stop some of the most abusive prior authorization practices. It's a small step, as you said, but it's an important step, and it's legislation that individuals can use to actually make more informed choices. I urge everybody to support this bill and I yield back.

Gentlelady yields back now, recognizes gentlelady of uh uh Dr. Miller-Meeks for her

Even bother to look at. prior authorization, the number of times it's utilized, and the number of denial claims. Okay. So I'm gonna give you a real world example of that. Okay. As an ophthalmologist in a small town in rural Iowa, I had a thirteen year old boy referred to me from a Of course, the thing. Okay. rock that hit him in his eye coming from a lawnmower. Yeah. He was driven into the clinic by his parents. Were appropriate. He had an open globe, meaning a corneal laceration, which needed to get repaired. And we then spent the next several hours trying to get prior authorization from his insurance company in order to repair his open globe. the child may easily have lost his eye and lost his vision. Now, if that's important to you as a parent, if that's important to you as a patient, then you want to know if your insurance company is systematically using prior authorization to delay care or to deny care, and if they're using denial of claims to deny care. If you're wondering why you haven't gotten your bill from your doctor's office, often it's because it's gone to the insurance company, they've denied the claim, then your provider has to go through this

Jen Lea yields back. Anyone else uh wish to dis uh be recognized to discuss the bill? Seeing none,

Okay.

the question now occurs on forwarding H R nine three nine six to the full committee. All those Aye.

Aye.

Those opposed no. The ayes have it. And the bill is forwarded to the full committee. Now call up H R nine three nine zero and ask the clerk to report.

H R ninety three ninety. To amend title twenty seven of the Public Health Service Act to require certain facilities to post prices on the walls. Be it enacted by the Senate and House y House of Representatives of the United States of America and Congress assembled. Second.

Without objection, the first reading of the bill is dispensed with and the bill will be open for amendment at any point. Seeing no objection, so ordered, and now recognize the gentlelady from Iowa, Ms. Miller-Meeks, to explain the bill.

Uh, thank you, uh, very much, Mister Chair. I move to strike the last word on my bill, H R ninety three ninety, the prices on the wall, act of twenty twenty six. As a physician, I've spent my career helping patients navigate a health care system that is too often confusing frustrating and far too expensive. One of the biggest challenges patients face is not knowing what something will cost until weeks or even months after receiving care. Imagine walking into a grocery store, a hardwood store, or a restaurant and finding that none of the prices are listed. You would never know what you were expected to pay until after you left. Yet that's exactly how the health care system often works. That's why I'm proud to introduce the Prices on the Wall Act of twenty twenty six. My legislation takes a simple, common sense step towards greater transparency. Beginning in twenty twenty eight, hospitals, ambulatory surgery centers, laboratories, and imaging providers would be required to post the prices of commonly shoppable health care services in visible locations where patients can easily see them before receiving care. The bill requires facilit facilities to display their discounted cash prices or when those are unavailable often readily understandable price information directly on their walls for patients to review. For years, policymakers on both sides of the aisle have to increase health care transparency. My bill builds on those efforts by making price information more visible and accessible to the people who need it most. Health care consumers deserve the same transparency that exists in virtually every other sector of our economy. Price transparency empowers patients. It encourages competition. It rewards providers who deliver the highest quality care at the most affordable cost. And it helps families make informed decisions about where they seek care. This is not about increasing bureaucracy, it is about providing patients with clear information. It is about respecting consumers and bringing greater accountability to our health care system. Americans work hard for every dollar they earn, and they deserve to know what price they are paying before they receive a service. Transparency is not a partisan issue, it is a patient issue, and I have put that into effect in my practice, so it is doable. I urge my colleagues to support the prices on the Wall Act, and I yield back. Thank you, Mister Chair.

Gentlelady yields back. Anyone else wishing to discuss the bill? Recognize the gentleman uh from New Jersey, Mister Pilon, ranking member of the full committee for five minutes.

Thank you, Mister Chairman. I I'm opposed to the bill, and while I support efforts to bring transparency to our nation's health system, this bill does not strengthen transparency or address the healthcare affordability crisis created by President Trump and congressional Republicans in my opinion on the contrary, I'm concerned that the bill will cause more confusion consumers and deter them from seeking care i i and don't get me wrong the intent of this bill is a good one to bring more transparency but i am concerned that this is just going to create more confusion because the prices that will be posted on the wall are not actually the prices that most patients would actually pay for those services the bill says that all hospitals ambulatory surgical centers labs and imaging centers have to post cash prices for healthcare services that can be scheduled in advance. And this includes hundreds and possibly thousands of procedure codes that providers will be required to post on the wall, right? Now hospitals are already required to publish their price information online, including for shoppable services, but requiring hospitals to post cash prices on their walls for various procedure codes would likely only confuse patients and deter insured individuals from seeking care. So patients who need care will also have to determine which procedure and billing codes that are ancillary will be furnished as part of the service. So I just think that the bill creates, you know, sort of a false sense of transparency that will make it even more difficult for consumers who are already struggling to navigate and understand the course of a healthcare procedure I don't see how it helps but I know you're well intentioned, but I I would urge a no vote on the bill.

And the gentleman yields back. Further discussion on the bill. Seeing none, the question now occurs on forwarding H R nine three nine zero to the full committee. All those in favor say aye. All those opposed no.

No. No.

The ayes have it. And the bill is agreed to and forwarded to the full committee. Now call up H R three five one four. And ask the clerk to report.

H R thirty five, fourteen, to amend title eighteen of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans.

Without objection, the first reading of the bill is dispensed with, and the bill will be opened for amendment at any point. Seeing no objection, so ordered. Does anyone uh seek to be recognized on the bill? General Uh, gentleman from Pennsylvania, Doctor Joyce, is recognized to speak to the bill.

Thank you, Mister Chairman, I wish to add my own support to HR thirty five fourteen, the improving seniors timely access to care act, and urge the swift passage of this crucial bipartisan legislation by our committee. I would also like to directly thank you and Chairman Guthrie, ranking members Pallone and DeGette, for bringing this bill to us today. This bill represents truly a bipartisan product that is currently supported by over two hundred ninety house cosponsors and has the endorsement of hundreds of patient, physician, and health plan advocacy organization. The Seniors Act will make critical improvements to the prior authorization process in the Medicare Advantage program, reducing administrative barriers that will ultimately ultimately deliver faster and more complete care to patients. Specifically, this bill requires MA plans to adopt standardized electronic prior authorization systems to expedite the processing of requests. This will improve transparency around the utilization of prior auth- in MA, it clarifies HHS authority to set timeliness for determination, and finally, mandates long-overdue oversight into the prior authorization process. This represents a consensus, common sense fix to one of the glaring issues facing providers and patients today. I urge all of my colleagues to support this legislation and I yield back.

Chairman yields back. Now recognize the gentlelady from Washington, Doctor Schrier, for five minutes to discuss the boo.

Thank you, Mister Chairman. Uh, I am so happy that this committee is moving the long-overdue bipartisan legislation, the improving seniors' timely access Uh, this is a big deal. I hear from my constituents all the time that the health insurance that they have is not holding up its end of the bargain. Insurance companies are delaying or denying care due to really abusive requirements for prior authorizations where there should not be that requirement. By the way, I hear the same frustration from doctors and from hospitals. They're forced to hire more staff just to process prior authorization requests than nurses. And the most egregious offender in all of this is Medicare Advantage, which is a type of Medicare plan that contracts with private insurance companies to deliver care, and more than half of seniors are enrolled in Medicare Advantage plans because um they're often more affordable and they seem great, until patient gets sick and can't get the treatment that their doctor recommends because of abuse of a prior authorization requirement. Uh in twenty twenty four traditional Medicare beneficiaries saw around six hundred and twenty uh six hundred and twenty five thousand prior authorization requests. Now here's a contrast. In that same year, Medicare Advantage beneficiaries saw over fifty million prior authorization requests. And I want you to keep in mind that enrollment in these programs is about fifty-fifty, so this is really disproportionate. This bill is an important step toward doing the right thing for seniors by requiring Medicare Advantage plans to adopt an electronic prior authorization system and to improve transparency around Medicare Advantage prior authorization use and potential abuse I urge my colleagues to vote for this bill and once we pass it into law I look forward to working with the committee to pass even more prior authorization reforms that put the doctor and the patient and not the insurance company back in charge of clinical decision making. Thank you. Yield back.

Gentlelady yields back. Anyone else wish to discuss the measure? Recognize the gentlelady from Iowa, Doctor Miller-Meeks, for her five minutes to discuss the bill.

Uh, thank you, Mister Chair. I move to strike the last word. I rise in support of H R thirty five fourteen, the improving seniors' timely access to care act of twenty twenty five. As a proud original cosponsor of this bipartisan legislation, and as a physician, I've seen firsthand the frustration patients' when administrative delays stand between them and the care they need. While prior authorization can be an important tool to ensure appropriate care and managed costs, the current process is too often outdated, outdated, burdensome, and unnecessarily time-consuming for both patients and especially providers. This bill takes a common-sense approach to modernizing prior authorization within seniors' health insurance advantage plans. It streamlines the process through electronic prior authorization, improves transparency, establishes clear timelines for decisions, and increases accountability so patients and providers have greater certainty when seeking medically necessary care. Let me give you an example of medically necessary care. I saw a patient with very uh symptoms that were uh very subtle, uh no signs, and I suspected that the uh patient had a base of the brain brain tumor. A CT scan will not diagnose a base of the brain brain tumor because the bone gets in the way. Through prior authorization, multiple hours by my staff, multiple hours on the phone by myself, they would not approve an MRI, which was what we requested. They finally approved, months later, a CT scan, then it's scheduled and it takes a couple of weeks, then you get the results, and guess what? The CT scan didn't show anything. So the next test you have to order is now an MRI. We finally got the authorization for the MRI, we finally got the MRI, and guess what the MRI showed? Lo and behold, even though the patient had no signs and very sh- few symptoms, the MRI showed a base of the brain brain tumor. Now, six months of delay for this patient could have been life-threatening. This is an important issue that should have, as Doctor Schreier and Doctor Joy said, already been addressed. So for seniors, this means fewer delays and faster access to treatment and sometimes life-saving treatment. For physicians and other providers, this means less time spent on paperwork, and more time spent on actually caring for patients, which is what we prefer to do. And for rural providers, including many in the my district in Iowa, it means reducing administrative burdens that can be especially challenging for smaller practices with limited staff and resources. Importantly, this bill does not eliminate prior authorization, rather it improves the process so it works more effectively for patients, for providers, and health plans alike. This legislation has earned broad bipartisan support because it addresses a problem everyone recognizes while preserving the benefits of appropriate utilization management. I thank the chairman, ranking member, and my colleagues for their work on this legislation, and I urge support for improving seniors' timely access to care. I yield back.

Gentlelady yields back. Now I recognize the gentlelady of Texas, Miss Fletcher, for her five minutes to discuss the bill.

Thank you so much, Mr. Chairman. Um, and I just wanna join with my colleagues on both sides of the aisle who um are speaking up in support of this bill I will keep it brief but I appreciate all the physicians uh who have weighed in um and while I am not a physician I represent a whole lot of them um who work at the Texas Medical Center and throughout my district, and one of the things I've heard about from them as well as from their patients um is the problem with prior authorizations. They just tell me consistently that it slows down access to appropriate care, forcing the physicians, their staff, the patients, everybody is on the phone, calling insurance companies, trying to um get approval for the care that their um that their physicians think that they need it's totally wasted time worse health outcomes. And one of the things that I'm also hearing it's really contributing to is the high rate of burnout. We're trying to get more people access to more care and you're wasting doctor's time, patients' time, staff time, um, and you're seeing physicians retiring earlier. Uh, we're already talking in this committee about a workforce shortage. We need to do things that make it easier for them to practice and easier for their patients to get the care that they need. And certainly, as Doctor Schreier mentioned, it is really clear that prior authorization needs to be reformed generally, and I hope that in addition to this we will be taking on more prior authorization legislation. but it is particularly acute in Medicare Advantage plans. And so many seniors are relying on Medicare Advantage for health care, and I think we've all seen um the challenges that they face in just trying to get the care they need. So that's why I'm really glad that the committee's considering this bill today. Um this is why I of course am a cosponsor of the bill. It really is a critical step in reforming the current prior authorization requirements in Medicare Advantage. and ensuring that seniors have access to quality health care. So, um, I hope this alleviates some of those burdens and I, again, like Doctor Schreier, I hope this is the first of many things we can do to help address this problem. And with that, I thank you and yield back.

And lady yields back. Anyone else wishing wishing to discuss the bill? Mister Carter of Louisiana is recognized for his five minutes to discuss the bill.

Move to strike the last word.

Gentlemen's recognized.

As a proud sponsor of HR thirty five fourteen, the improving seniors timely access to care act of twenty twenty five, I am pleased to speak in support of this bipartisan legislation led by Representative DelBene and Kelly. Louisiana's Louisiana State has one of the highest percentages of MA enrollees in the country, many of whom live in my district. That is why ensuring seniors can access high quality care without unnecessary delays in prior authorizations for me and my constituents is essential. The improving seniors timely access to care act of twenty twenty five would take steps to strengthen the Medicare Advantage program and improve the experience of seniors who rely on it in states like mine. More specifically, the bill would increase transparency, streamline the prior authorization process, and expand protection for enrollees. These reforms would also help to reduce administrative burden on physicians and allow for more time to be spent with patients. I support my colleagues' bipartisan effort to improve the Medicare Advantage program for seniors and encourage my colleagues to join me in voting for this bill that will end the frustration for individuals who wait for their medication to be filled only to be told by their pharmacy that they're waiting for another prior authorization. While people oftentimes go without their medicine for days, weeks, waiting for a prior authorization, um, at what point do we get our arms around this? And I'm hopeful that this will be the step that we so desperately need to get relief to the patients and caregivers who deserve it. Um, with that, I yield.

Jim, when he yields back, anyone else wishing to discuss the bill H R three five one four? Seeing none, the question now occurs on forwarding H R three five one four to the full committee. All those in favor say aye.

Aye.

Those opposed, no. The ayes have it and the bill is agreed to and forwarded to the full committee. Clerk will now call up H R nine three nine two.

H R ninety three ninety two

And

to amend title eighteen of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data.

And without objection,

Be it in that

the first reading of the bill is dispensed with, and the bill will be open for amendment at any point. Seeing no objections, so ordered. And recognize uh Doctor Joyce speaking to the bill.

Thank you, Mister Chairman. I indeed wish to in support of hr ninety three ninety two the medicare advantage cost transparency act and thank ranking member to get for partnering on this important bipartisan piece of legislation this bill represents an important step in the right direction in improving encounter data submissions made by medicare advantage plans to ensure that they account for the total allowable cost for items and services and include the amount of cost sharing imposed on the beneficiary for such services. This higher level of transparency will help inform both the patient and the policy makers as we further evaluate the MA program with more objective data. This legislation will also provide for us important insight into the at-home health risk assessment services and actually who's furnishing those. While this bill represents a critical step towards greater transparency in the MA program, there's still work that needs to be done to ensure that this legislation accounts fully for the innovative plan designs that include value-based contracting in the allowed amounts to ensure that we are truly capturing the entire picture. I am also committed to ensuring that this legislation is building in a clear, uniform standard so that the data is genuinely comparable across plan types, and we don't distort the very transparency that we are working to create. I look forward to working with ranking member DeGette, urge that this subcommittee advance this bill today, and continue working this bill in a bipartisan manner between now and the full committee. I yield back.

Gentlemen yields back, I now recognize the ranking member of the subcommittee, the gentlelady from Colorado, Ms. DeGette, to discuss her very good bipartisan bill.

Thank you, thank you, Mister Chairman, and thank you to my friend, Mister Joyce, for working on this bill with me. Um, back when I was the chair of the Oversight and Investigation subcommittee, and you, Mister Chairman, were the ranking member of that committee, we held a hearing on Medicare Advantage with the GAO, OIG, and MedPak. And the message from the watchdog agencies was loud and clear. We need a complete, accurate, valid encounter data if we want Medicare Advantage to succeed. This bill takes to t- seeks to take another step in doing that, giving policymakers, the federal government, and researchers the cost information we need to have while we find out what Medicare Advantage plans are paying for care, and what ma- patients themselves are paying out of pocket. The program is an important option for our seniors, but all of us are deeply concerned by evidence that patients are not getting the care they need, private insurance companies are gaming the system to profit from taxpayer dollars. That's why the bill also requires a particular look at the practice of home health risk assessments which insurers use to code patients as sick receive greater compensation from the government and not actually contact or connect seniors to care. The information will help us protect our seniors enrolled in Medicare Advantage which is thirty-five million and growing. and the long-term viability of the Medicare program. Um, I hope that our colleagues will all join Doctor Joyce and me on this effort, and vote in favor of the bill, and I yield back.

Gentle lady yields back. Does anyone else wish to discuss the bill? Seeing none, the question now occurs on forwarding H R nine three nine two to the full committee. All those in favor say aye. Those opposed, no. The aye has it, and the bill is agreed to and forwarded to the full committee. Now call up HR five two four three and ask the clerk to report.

HR fifty two forty three, a bill to amend title eighteen of the social security act to increase data transparency for supplemental benefits under Medicare advantage.

The without objection, the first reading of the bill is dispensed with and the bill will be opened for amendment at any point seeing no objection so ordered, does anyone seek to be recognized on the bill?

I'm looking.

I recognize the gentlelady from Colorado, Miss DeGitt, to speak to

You're speaking on your

HR five two four three.

first. Um, Mr. Chairman, Medicare Advantage plans often woo seniors with enticing supplemental benefits that traditional Medicare just doesn't offer. But benefit beneficiaries often find when they're enrolled, these supplemental benefits are beyond or behind barriers to redeeming them, or seniors simply don't utilize the full range of supplemental benefits available to them. In addition to under-utilization concerns, supplemental benefits have been added to the Medicare program without a real policy debate about how they're financed and whether they're thought, meaningfully improving seniors' health. This bill would require Medicare Advantage plans to disclose exactly which supplemental benefits they offer, how seniors are utilizing them, and how much they cost. That way, policymakers have a clear view of supplemental benefits to ensure both success of Medicare Medicare Advantage and long-term viability of the larger medical Medicare program I would like to commend our colleague from the full committee Representative McClellan for her great work in developing this bill, and I yield back.

Gentlelady yields back. Any further discussion? Recognize the gentlelady from uh Washington, Doctor Schreier. Gentlelady is recognized for five minutes.

Thank you, Mister Chairman. Um, we we've all seen the marketing for Medicare Advantage plans, free gym memberships, and free golf clubs, and zero premiums. Um, it is quite the sales pitch, and as I've mentioned before, these plans sound great until you actually have a health challenge and then you face a mountain of prior authorization requirements to get the care you need. Um, but supplemental benefits are one of the big driving factors behind increasing enrollment. in medicare advantage plans. These benefits range greatly but can include everything from vision, hearing and dental to gym memberships and more. And these are really nice benefits and it makes sense that seniors factor them into their enrollment decisions. But it's really hard to measure the value of these benefits when we don't have reliable data on how much seniors are actually using them and what they cost. As policymakers, Uh, we need this data so we can improve Medicare Advantage plans and ensure that they're actually delivering the benefits and care that seniors deserve. It's also a great way for us to consider whether other things would be better, more effective supplemental benefits, like uh medically tailored meals. I wanna express support for this important bill that will finally give Congress more insight into the utilization of supplemental benefits provided by Medicare Advantage plans. It's a thoughtful and important step toward uh toward reform and I encourage my colleagues to vote yes. Yield back.

General, I yield back, anyone else wishing to discuss H R five two four three. I have an ease. Um there's an amendment uh uh um Representative Pilon of New Jersey.

Uh, Mister Chairman, I have an amendment at the desk labeled amendment in the nature of a substitute to amend title

Eighteen of the Social Security Act. Will clerk call it up, please?

Amendment in the nature of a substitute to H R fifty-two forty-three. Off the ground.

Wave the reading without objection, wave the reading of the amendment. Recognize the gentleman from New Jersey for five minutes to discuss or explain his amendment.

Thank you, Mister Chairman, my amendment makes technical and conforming changes based on technical assistance to H R five two four three. The bill led by Representative McClellan a Medicare Advantage insurance company to report data on supplemental benefits. Medicare provides health coverage for over sixty-four million beneficiaries and is the single largest payer of health coverage in the US, and more than half of all Medicare beneficiaries are now enrolled in an MA plan. Medicare spending is expected to double over the next ten years with payments to MA insurance companies totaling over nine trillion dollars. While the MA program offers seniors flexibility in the way they receive their medical care, it's important that we ensure Medicare remains financially viable, and that seniors are receiving the high quality care they deserve. Now the Medicare Payment Advisory Commission has consistently found that providing care under the MA program has cost more than under traditional Medicare. In twenty twenty-six, payments to MA plans were expected to be fourteen percent more per beneficiary, totaling seventy-six billion dollars in overpayments to insurance companies. If this trend continues, it will translate to one point two trillion dollars in overpayments to MA insurance companies over the next ten years. And despite the large costs associated with the MA program, there is limited data to conduct oversight and ensure that the program is providing good value for our federal dollars. The federal government is expected to spend over one trillion dollars over the next decade on MA supplemental benefits alone, yet there is limited data about the scope of supplemental benefits offered. In particular, there has been no meaningful about whether or not seniors are actually using supplemental benefits, and if their usage correlates to the additional money insurance companies are being paid. There's also very limited data about how it may plan cost sharing reductions effect on rolees. So, due to the incomplete and limited data, it is challenging to determine the value of supplemental benefits to seniors and to taxpayers. As Medicare payments for supplemental benefits continue to increase, we must better understand if they're helping seniors, and whether they're being delivered at a reasonable cost. I'm also concerned that all Medicare beneficiaries are having to pay higher premiums to pay for these supplemental benefits though not all have access to these services so this bill HR five two four three would require plans to report on enrollee level data on supplemental benefits and will provide important data to regulators and policy makers to help us conduct oversight and assess the program performance I would urge members to support the aims and as well as the underlying bill. And with that, Mr. Chairman, I yield back.

Gentleman yields back. Any further discussion of the amendment of the nature of substitute? Seeing none, uh, the vote occurs on the amendment. All those in favor of the amendment of the nature of substitute offered by the gentleman from New Jersey shall signify by saying aye. Aye.

Aye.

All those opposed, nay. The ayes have it. The amendment of the nature of substitute is agreed to. Any further discussion on the underlying bill?

H R ninety three ninety five. To amend title eighteen of the social security

Mm.

to require certain reporting with respect to agents and brokers of Medicare Advantage organizations. Be it in the

Without objection, the first reading of the bill is dispensed with, and the bill will be open for amendment at any point. Any objection? Seeing none, so ordered. And I will now recognize the gentlelady from New York, Ms. Ocasio-Cortez, to uh explain her bill.

Thank you, Mister Chairman, and I'd like to thank the Chairman and Ranking Member for including my bill the Transparency and Medicare Advantage Steering Act. I've spoken about Medicare Advantage many times in this committee, and I believe we need wholesale reform of the program. But my bill before the committee today addresses one aspect of Medicare Advantage that needs reform and that's with our agent and broker system. As many know, Medicare Advantage is not traditional Medicare. It is private health insurance run by for-profit health insurance companies. And those health insurers make more money if they have more people enrolled in their particular MA plan. And that's where agents and brokers come in. Health insurers pay agents and brokers to steer people towards their MA plans. And in other words, these brokers are financially incentivized to enroll individuals in specific plans. Even though Medicare Advantage is private for-profit insurance, it is funded by public dollars. And that means this is all done with taxpayer dollars. And we're talking about billions. According to a study conducted by Brown University, agents and brokers reportedly received ten billion dollars from Medicare Advantage insurers for enrolling people into specific programs in twenty twenty two. And many researchers who conducted this study uh believe that this ten billion dollar figure is likely an underestimation. My bill would address this lack of transparency. It would require for-profit health insurers with Medicare Advantage plans to report on whether their members used an agent or broker to enroll in one of their plans, the amount of compensation health insurers provided to those brokers, and the type of compensation they provided. So we know if agents and brokers are receiving a free vacation or a bonus for enrolling someone in one plan over another. My legislation would make all of this information publicly available. While there were other portions of the bill that were not included in the mark-up, um, they were discussed at the legislative hearing two weeks ago. And the filled bill includes a provision to limit the compensation provided to agents and brokers and redefine what is even considered compensation. Um, uh, nevertheless, I look forward to moving this critical transparency piece forward so we can collect the information we need to enact greater reform to the Medicare Advantage program. I urge my colleagues to support this legislation and I yield back. Thank you.

Jen Levy yields back. Any further discussion on the underlying Bill HR nine three nine five? I recognize Jen Levy from Washington and Dr. Schreier for her five minutes to discuss the bill.

Thank you, Mr. Chairman. Uh, I'm really glad this committee's moving important legislation to provide much needed transparency when it comes to the broker and agent system that is influential in steering seniors towards certain Medicare plans, I just wanna start by saying Medicare's really hard to navigate, and choosing any insurance is challenging. Uh, so seniors absolutely need assistance and guidance when finding the right plan for them. Um, but that assistance should be independent and unbiased and guided by what, uh, helps the seniors most. Uh, the current system, though, prioritizes sales volume over beneficiaries and We know insurance companies are steering seniors into their own Medicare Advantage plans rather than helping patients find the best plan for their own health needs. Brokers and agents receive higher commissions when they enroll seniors in Medicare Advantage plans compared to traditional Medicare. However, when studies have asked those same brokers and agents what plans they would personally choose, many of them say traditional Medicare plans with a meta-gap supplemental policy over Medicare advantage. That really says everything you need to know. We need to align financial incentives with what's in the beneficiary's best interest. Financial advisors have a fiduciary responsibility, and those that guide seniors in choosing a Medicare plan should have that same responsibility and we have a proven model that works the federally funded ACA navigator program that helps beneficiaries Bene beneficiaries enroll in ACA health plans, the one that works for them, and there are no kickbacks. I am proud to support this legislation, which would require insurance companies to provide transparency around broker compensation and I encourage my colleagues to vote yes, yield back.

Gentlelady yields back. Any further discussion on uh HR nine three nine five? Seeing none, the question now occurs on forwarding H R nine three nine

Aye.

Aye.

Opposed no? The ayes have it. The bill is agreed to and forwarded to the full committee. Without objection, staff is authorized to make technical and conforming changes to the legislation approved by the committee today. Seeing no objections, so ordered. The committee stands adjourned.

What a great job.

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