WASHINGTON, D.C. – Ways and Means Committee Chairman Jason Smith (MO-08) delivered the following opening statement at a Committee markup of legislation to expand access to quality, more affordable health care and hold health care empires accountable.
As prepared for delivery.
“One out of every five dollars in our economy is spent on health care. And for their money, Americans get a system where the prices are hidden and the decisions that matter most get made behind closed doors by everyone except the patient.
“This Committee has been working to expand access to quality, more affordable health care, particularly in rural and underserved areas. We’ve identified specific failures, and today we are taking decisive steps to hold health care empires accountable and improve the health of our communities.
“The bills before us share a common goal: put the American people in charge of their own health care. President Trump’s Great Healthcare Plan rightly calls for real transparency and real accountability. This Committee intends to deliver it.
“Among the lessons learned from the COVID-19 pandemic was how many states discouraged visitation or banned it outright, leading to heartbreaking stories of seniors enduring loneliness and even facing their final days without loved ones present. Representatives Tenney and Larson have introduced bipartisan legislation that prevents this from happening again. Their bill enshrines seniors’ visitation rights at nursing homes and other kinds of facilities during an emergency by requiring nursing homes to admit essential caregivers who provide seniors critical assistance and support.
“Next, the committee will consider legislation to protect patient access in rural and underserved areas to remote health monitoring services while acknowledging that disparities exist in access to this life-saving technology. Representative Kustoff’s bipartisan legislation ensures that Medicare beneficiaries in rural and underserved communities are not left behind by advances in digitally assisted care. I once had a health care innovator tell me that he is paid between two and three times as much for remote patient monitoring in San Francisco as he is in rural Missouri for the exact same service. Since health care always follows the dollar, a disparity that wide is creating a huge access issue. Requiring Medicare to adequately reimburse for these services will give rural and underserved patients and their physicians access to a more complete view of a patient’s health. This can be transformative and even lifesaving when it comes to treating chronic disease.
“Our next piece of bipartisan legislation introduced by Representative Moolenaar recognizes the need for preserving anesthesia services and surgeries in rural areas by addressing a Medicare payment disparity for rural anesthesiologists. Rural communities already suffer from a lack of medical professionals. 81 percent of rural communities lack an anesthesiologist, and more than half have no access to such services. Protecting access to anesthesia services will protect access to surgical procedures in rural communities. This bill will incentivize anesthesiologists who live in urban areas to practice in rural hospitals by extending them the same bonus payment currently offered to anesthesia nurses, sustaining access to care for patients.
“Long-term care hospitals serve patients with a serious injury or illness that requires prolonged inpatient treatment. However, current law requires patients who need this long-term care to check Medicare paperwork boxes by spending a certain number of days in a hospital ICU or a certain number of hours on a ventilator before they can access this care. In many cases, this is a needless delay when years of experience have taught providers how to spot patients who will need long-term acute care. Legislation we are considering today – championed by Representatives Hern, Miller of West Virginia, and Smucker – allows providers to assess early on whether a patient will need long-term care and get those patients the care they need – without wasting their time. This bill also treats rural critical access hospitals the same as standard hospitals so patients in rural and underserved areas are not forced to travel long distances to an urban facility before they can be given the same diagnosis and transferred to long-term care. In short, this bill gets patients to the care they need sooner rather than later, while freeing up hospital beds and providers to treat other incoming patients. The need is dire. Already, of the 421 LTCHs that existed in 2012, 83 have closed – including one in my district. We must act before patients lose access altogether to a critical source of care for some of the most critically ill patients.
“Next the Committee will consider legislation authored by Tax Subcommittee Chairman Kelly alongside Representative DelBene that enjoys broad bipartisan support in the House of Representatives. This bill tackles a chronic problem affecting seniors in all our communities and threatening access to care while enriching insurers: prior authorization in Medicare Advantage. For the nearly 33 million seniors on Medicare Advantage – over half of all Medicare beneficiaries – the prior authorization process has become a barrier to timely health care services. Members of this Committee have expressed well-founded concerns that insurance companies are abusing this process – particularly when nearly 81 percent of authorization denials that are appealed are later overturned. This bill follows the great work that President Trump, HHS Secretary Kennedy and CMS Administrator Dr. Oz have championed, securing commitments from the nation’s largest health insurers to improve this arcane process and puts the President’s Great Healthcare Plan into law. This bill will force insurers to be transparent about their prior authorization practices. It also requires them to invest in new electronic prior authorization tools to ease burden for physicians and hospitals, benefiting patients.
“Our next bill brings transparency to health insurer finances and enrollee benefit information. Medicare Advantage insurers are some of the most profitable companies around, with one insurer posting more than $6 billion in profit in the first quarter of this year alone. Yet basic information is still unavailable to the public. At the same time, insurers add to patient confusion when they don’t display benefit information clearly. Representative Moran’s bill shines light onto these financial windfalls. It requires Medicare Advantage insurers to publicly post their revenue and spending on medical services compared with administrative costs and profits while requiring them to better display benefit information to patients. Seniors and taxpayers deserve to know this information before they hand over their money.
“Our last piece of legislation ensures hospitals and insurance companies tell Americans the price of care before they owe a dime. Where I come from, you know what a truck costs before you drive it off the lot. Health care is the only thing in America you buy blind. That’s not a mistake; it’s how the system was built. The hospital knows the price. The insurance company knows the price. The middleman knows the price. The only person who doesn’t is the patient getting stuck with an unexpectedly high bill months after a procedure.
“This legislation builds upon the work this Committee has done through hearings, including with CEOs of the nation’s largest health insurers and health systems, and markups and field hearings focused on greater access and affordability.
“In his first term, President Trump made hospitals and insurers post their prices. Then the last Administration slow-walked enforcement and looked the other way while hospitals and insurers failed to live up to their commitments to be more open and honest with patients. My legislation codifies and strengthens President Trump’s rules to hold hospitals and insurance companies accountable for delivering transparency to patients.
“So much of the work this committee does reflects bipartisan consensus. We all have seniors and families in our district who will benefit from greater health care price transparency and improved access to care – particularly those Americans in rural and underserved communities.
“Today’s markup is another opportunity to show how we can bring bipartisanship to solving real challenges facing the American people.”