Congress

Primary care changes could be part of Senate effort to lower health care costs

A committee discussed ideas including provider incentives to buy drugs directly from wholesalers, and encouraging employers to offer on-site clinics

Sen. Elizabeth Warren, D-Mass., right, and Tina Smith, D-Minn., talk with attendees of the a Senate Health, Education Labor and Pensions Committee hearing in the Dirksen Senate Office Building on Sept. 25, 2018. (Photo By Tom Williams/CQ Roll Call)

A Senate Health, Education, Labor and Pensions Committee hearing on Tuesday highlighted changes to primary care coverage that could be part of a Senate effort to lower health care costs this year.

Those ideas include incentives for providers to buy drugs directly from wholesalers, expanding which services qualify for health savings account purchases, encouraging employers to offer on-site clinics to workers, and clarifying how direct primary care programs can help physicians reduce time spent on administrative tasks.

Committee Chairman Lamar Alexander, R-Tenn., has said he hopes to pass legislation this year to lower health costs, including for prescription drugs. Lawmakers have already signaled that curbing surprise medical bills will be part of the push, and Alexander has been soliciting proposals from experts and stakeholders.

“We’re not going to have less expensive health insurance until we have less expensive health care costs,” Alexander said during the hearing. “While there are no silver bullets in life, I’ve learned there are sometimes levers that can make a difference, and primary care seems to be a logical, sensible focus for anyone seeking to improve outcomes, improve experiences and lower costs.”

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Allowing providers to buy prescription drugs directly from wholesalers could be an area that the panel investigates further, Alexander said. Witness Josh Umbehr, a doctor from Kansas who opened a direct primary care practice that charges patients a monthly fee and does not accept insurance, said 44 states have laws that allow providers to purchase drugs directly from wholesalers.

“My question is why don’t they do that?” Alexander told reporters. “And are there ways to expand on-site employer facilities or direct primary care facilities that encourage or allow physicians to buy prescription drugs at a lower cost?”

He also explored changes to services qualifying for coverage through a health savings account, highlighting a proposal from Sen. Bill Cassidy, R-La., to allow monthly costs for direct primary care to be covered by such accounts.

Last year, the Republican-led House advanced a similar proposal, along with other legislation to expand the use of health savings accounts. The package, which included some more partisan provisions, was not considered at the time by the Senate.

Alexander said he has met with ranking member Sen. Patty Murray, D-Wash., along with the Finance Committee leaders, Sens. Charles E. Grassley, R-Iowa, and Ron Wyden, D-Ore., about how the Senate could consider health care costs this year.

Murray touted a bill to provide five years of funding for community health centers, which she introduced with Alexander, as a way to address health care costs. She also said the committee could consider ways to lower drug costs, prevent surprise balance billing, reverse what she called the Trump administration’s “sabotage,” and lower insurance premiums this year.

Several Democrats, including Sen. Elizabeth Warren, D-Mass., who is seeking the party’s 2020 presidential nomination, asked how primary care can better address behavioral health and substance abuse issues and how primary care providers can receive that kind of training.

“It’s clear that providers in primary care settings could also use more guidance on this,” Warren said, referring to a model called Project Echo. Another witness, University of Washington assistant professor Katherine Bennett, works with that program, which offers training to primary care providers.

“In Massachusetts, the Boston Medical Center has an Echo program that does exactly what you’re describing, helping providers in primary care settings across the state provide addiction treatment,” Warren said. “Our health care providers are getting really creative and they are working hard to provide their patients with the behavioral health care they need, but they need more support and training.”

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