H.R. 3020: Addressing Anti-Competitive Health Care Contract Clauses Act

This bill, titled the Addressing Anti-Competitive Health Care Contract Clauses Act, aims to address concerns over certain contractual clauses used in the healthcare industry that may be anti-competitive. Here is a breakdown of what the bill proposes:

Study by the Government Accountability Office (GAO)

Within 18 months of the bill being enacted, the GAO is tasked to conduct a study coordinated with the FTC and the Department of Justice's Antitrust Division. This study will:

• Evaluate the effects of specific restrictive contract clauses, including:
  • Anti-steering clauses: Provisions that prevent health insurers from directing patients to alternative healthcare providers.
  • Anti-tiering clauses: Clauses that restrict an insurer's ability to categorize healthcare providers in tiered plans.
  • All-or-nothing clauses: Clauses that compel insurers to include all providers from a healthcare system under a single contract or require additional agreements as conditions for contracting.
  • Gag clauses: Provisions that limit disclosures of pricing and quality information related to healthcare services.
• Assess the impact of these clauses on:
  • Consolidation in the healthcare sector.
  • Healthcare costs for consumers.
  • Access to healthcare services.
• Compile a list of actions previously taken by the FTC and the Department of Justice regarding these contract clauses.
• Determine if the FTC and the Department of Justice have adequate resources to enforce federal antitrust laws regarding these clauses.
• Provide recommendations for further legislative or administrative actions if necessary.

Reporting Requirements

The GAO must submit a report with the findings of the study to various committees in both the House of Representatives and the Senate, including:

• Committee on Energy and Commerce
• Committee on Ways and Means
• Committee on Education and Workforce
• Committee on the Judiciary
• Committee on Health, Education, Labor, and Pensions

Definitions of Key Terminology

The bill defines several terms related to the healthcare contracts it addresses:

• All-or-nothing clause: A requirement that binds insurers to include all members of a healthcare provider network.
• Anti-steering clause: A restriction preventing insurers from incentivizing patients to choose alternative providers.
• Anti-tiering clause: A limitation on insurers’ ability to categorize providers in tiered plans or restrict grouping into the same tier.
• Gag clause: A restriction on disclosing pricing and quality information, limiting transparency in contracts.
• Tiered network plan: A plan that sorts providers into different categories affecting reimbursement, costs, and access.

Overall Aim of the Bill

The overall goal of the bill is to investigate and assess the potentially harmful effects of these anti-competitive clauses in health care contracts and to ensure that there are effective mechanisms to uphold antitrust laws in the health care sector.

Relevant Companies

• UNH - UnitedHealth Group: As a major health insurance provider, changes in contract regulations could directly impact their business operations and strategy regarding provider networks.
• ANTM - Anthem Inc.: This health insurance company may need to adjust its contracts with healthcare providers if certain clauses are re-evaluated or restricted due to this legislation.
• CNC - Centene Corporation: Similarly, Centene might face operational changes regarding their contracts if anti-competitive clauses are affected by the outcome of the GAO study.