Senator Marshall: Broken ACA Sticks 24 Million Americans with $5,000 Deductibles
Senator Marshall Questions Witnesses at Senate HELP hearing
Washington – On Thursday, U.S. Senator Roger Marshall, M.D. (R-Kansas), questioned witnesses, including, Michelle Rosenberg, Director of Health Care at the U.S. Government Accountability Office, Aditi Sen, Ph.D., Chief of the Health Policy Studies Unit at the Congressional Budget Office, and William B. Feldman, MD, Dphil, MPH, physician and health policy researcher at the University of California, during the Senate Health, Education, Labor, and Pensions hearing focused on the 340b program and examining its growth and impact on patients.
Click HERE or on the image above to watch Senator Marshall’s full exchange.
Highlights from the hearing include:
On reevaluating the 340b and ACA programs:
Senator Marshall: “Thank you, Mr. Chairman, I just got to piggyback on and remind my friends across the aisle, the ACA is broken. 24 million people, their average deductibility is $5,000, that’s not access to health care. If you’re a family making $80,000 a year, a $5,000 deductible is not access to health care. And regardless of what we do in the next month or three, your premiums are going to go up at least 18% for the ACA plans. I’m just so waiting for you all to say we need to fix the fraud. We need to fix the cost. We need to fix the deductibles as well. Simply throwing money at a problem it doesn’t solve the problem. We need to actually go after the true issues: fraud, the premium increases, and the deductibility. But first, we need to get the government open. All right, let’s turn to 340b something. I’m pretty familiar with the 340b started off as a wonderful program, and my rural hospitals, my community health centers, are so dependent upon them. But it’s interesting to me, like many things in health care, my rural hospitals only get less than 2% of all the dollars spent on 340b go to rural hospitals, only 2% our community health centers. I mean, one of the greatest things that we’ve done and that we need to continue to fund more of these community health centers.
“You know, one of my MAHA pillars is meaningful, affordable access to primary care, integrating mental health, integrating nutrition, but the 340b program [is] vitally important to that population. But what we’ve seen, of course, are big, monopolistic hospital systems abuse the system, and you know, frankly, they’re taking 95% of the dollar, 94% of the dollars going to those, so it’s not being spent where it should be. And we’re here today to fix that. I know we formed committees, we prayed about it before we leave for Christmas. I hope that we have a legislation passed through committee, marked up, and I think we’re real close on what that looks like. I think it’s time to quit thinking about it and wondering we know what to do. We absolutely know what we need to do here. One simple thing is defining a patient. There are big hospital clinics that saw a patient five years ago. The patient has moved out of state, and they’re still using 340b for a profit center to sell to those patients. So I think I’m going to start with Miss Rosenberg. Any thoughts about how you would identify, define what a patient is in these 340b programs?”
Mrs. Michelle Rosenberg: “We have not specified a specific definition of a patient, but we do have an open recommendation to HRSA to clarify its guidance.”
Senator Marshall: “So what does the definition look like?”
Mrs. Michelle Rosenberg: “I think that is up to members of Congress. What I can say things to consider, such as the frequency or the recency with which an individual had been served by the facility. One thing to consider is whether or not it should be a per-prescription basis or not, and whether or not the drug that they’re providing is a result of a visit at that facility, or from a referral from that facility. Or is it unrelated? But those are things you could conduct.”
Senator Marshall: “Would you add anything to defining a patient?”
Dr. Aditi Sen: “We would certainly analyze that based on the specifics of how the patient definition was set. And I think you know any I expect that any narrowing of patient definition would, of course, have implications for spending in the program.”
Senator Marshall: “Okay, let’s talk about PBMs for a second. I think Senator Cassidy, Chairman Cassidy, he cited a GA report the concerns with the PBMs, and I appreciate the continued investigation into this. Let’s go back to Mrs. Rosenberg, since the free structures are generally the same for grantees like community hospitals, community health centers, and hospitals, would you say this places a disproportionate burden on grantees who typically operate are much tighter margins, and what transparency requirements could help us implement and prevent the divergence of resources?”
Mrs. Michelle Rosenberg: “So certainly, the compliance requirements are the same regardless of whether you’re a grantee or a hospital, and so if you are a smaller entity, then that may be more challenging in terms of transparency. I would note that HRSA does not have insight into contracts that entities may have with third-party administrators or others to help them.”
Senator Marshall: “Would you agree that PBMs are taking a chunk of this money?”
Mrs. Michelle Rosenberg: “We haven’t looked specifically at PBMs. We have looked at third-party administrators, and they do get paid for their service. Is it a significant amount of money or not? We don’t know. That’s not something that’s the problem.”
Senator Marshall: “If you don’t know, then I don’t know as well. Mr. Chairman, I went over my time again. I just beg this committee to mark up a bill, and let’s get this done. Thank you.”
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Contact: Payton Fuller
