As a member of the Energy and Commerce Committee and the Education and Labor Committee of the U.S. House Representatives, Congressman Brett Guthrie works on a range of issues important to his constituents. For example he’s deep into the policy weeds on ways to reduce prescription drug prices, address unexpected bills from out-of-network doctors, and make it easier for the disabled to remain at home.
But there’s one issue that he says really angers people in Kentucky’s 2nd Congressional district: automated telemarketing calls.
“It’s easy to be against robocalls,” says Guthrie. “It’s hard to stop people from making robocalls.”
The six-term Republican from Bowling Green discussed all these issues on KET’s Congressional Update.
The Rising Cost of Medicines
As with many health policy problems, Guthrie says understanding the roots of prescription drug pricing is more complicated that it might seem.
“People say it should be simple, just set a price,” he says. “But if you set a price, you get shortages.”
And that’s just the first challenge. Guthrie says there are amazing new drugs coming to market like a pill that he says can cure Hepatitis C. He says the initial cost for a course of that drug was $115,000. Now it’s down to a paltry $40,000.
“Those are called the blockbusters, Guthrie says. “So we’ve got to figure out how do you get those to the marketplace and make it affordable for people.”
Another challenge comes from existing drugs that haven’t changed in years, yet their prices still increase. A recent example is insulin, which is used by more than 7 million diabetics in the United States. The Health Care Cost Institute says the point-of-sale cost of insulin nearly doubled from 2012 to 2016. That’s caused some patients to seek insulin from Canada, Mexico, or the black market.
To understand the mechanics of drug pricing, Guthrie and his committee colleagues have heard testimony from pharmaceutical companies, private insurers, and pharmacy benefit managers that administer prescription drug programs.
“What we’re trying to figure out is what’s really driving these increases,” the congressman says. “We have people pointing fingers at each other.”
The congressman says he hopes to see legislation that would enable individuals with no insurance or with coverage that includes high co-pays and deductibles to pay the lower net price for drugs, which is what insurance companies pay, instead of the higher list price. He says consumers should get the benefit of those price breaks, not just insurance companies. Guthrie also wants to make more generic drugs available as another way to save people money.
The Energy and Commerce Committee did send a drug-pricing bill to the full House that Guthrie says could have garnered near unanimous support. But he says House Speaker Nancy Pelosi attached the drug measure to a larger health care bill related to the Affordable Health Care Act, which Republicans opposed. Guthrie says Congress needs to find some way to act on drug prices.
“It’s going to lead to bankrupting our system because these drugs are getting so expensive,” he says.
Another health care issue on Guthrie’s agenda is so-called surprise medical billing. That happens when a person receives health care from a provider who is outside of their network of coverage. As a result, those services are billed at much higher rates than those performed by an in-network doctor. Guthrie says just because the primary physician doing a procedure is in-network doesn’t guarantee that the rest of the team is. He says a patient may have no idea that the anesthesiologists working their surgery or the pathologist who reads their colonoscopy screening could be out of network,.
“You can do everything right as a consumer of health care and still be surprised,” the congressman says. “So we’re trying to come up with a way that if you do go to your principal physician or medical provider who is in your network, then you don’t get billed for all these other services that are out of network.”
Guthrie says surprise billing is especially problematic for people who have high deductibles and copays.
“Somebody may have a $10,000 deductible and they’ll get a $7,00 bill because this person’s out of network,” he says.
Resolving surprise billing is tricky, says Guthrie, because a solution that seems reasonable can have unintended consequences. For example, price controls could force specialists out of the marketplace and create shortages, he says. The congressman says one option is to let insurance companies and care providers resolve the matter through arbitration.
“All the insurance plans, the hospitals, and physicians groups say, ‘We want to take the patient out of it,’” Guthrie says. “‘Let’s figure out a way we can come up with the right pricing amongst ourselves.’”
A discussion draft of bipartisan legislation on surprise billing is before the House Energy and Commerce Committee, according to Guthrie. He says he thinks the House could approve a bill on the issue later this year.
Allowing Medicaid to ‘Follow the Person’
Earlier this year Guthrie introduced legislation to allow certain Medicaid beneficiaries to be compensated for long-term care they receive at home. Currently Medicaid only pays those costs for people who are in long-term care facilities like a nursing home. Guthrie says his EMPOWER Care Act, which he cosponsored with Democratic Congresswoman Debbie Dingell of Michigan, does not force people out of facilities, but allows them to decide the care situation that is best for them. Federal Medicaid money would then follow the person wherever they choose to go.
“So if somebody in an institution… wants to be at home or can be at home and it’s proper for them to be at home, then they can get the Medicaid dollars to support [that],” says Guthrie. “It’s cheaper for the public, it’s better for the family.”
As for comprehensive health care reform, the congressman says he hopes President Donald Trump will lead that charge.
“I would love to see the president put together a team of people, and I would love to be a part of that team,” Guthrie says. “Let’s have a White House conference and come out with a bill we can all agree on.”
But with the 2020 elections on the horizon, tackling such a weighty issue in a way that can win support from Democrats, Republicans, and the president won’t be easy. Guthrie contends it’s time for everyone in Washington to come together to address health care.
“We can’t just not get stuff done half of our term because everybody’s up for reelection next year,” he says. “So hopefully if we can’t get it done by this fall, we will focus to get something done by next fall.”
Blocking Automated Phone Calls
Guthrie is a cosponsor of the Stopping Bad Robocalls Act currently before the House. Robocalls are made by computer systems that can dial thousands of phone numbers at once, mask the source number of the call, and then deliver a prerecorded message to the person who answers the telephone.
The bipartisan measure requires phone companies to install technology to block robocalls. Consumers would opt-in to the blocking feature without being charged extra by phone carriers. It also requires those companies to implement call authentication technology that enables consumers to trust the caller identification number displayed on their phones.
The congressman says the robocall issue is one of the top concerns of his constituents, especially senior citizens and business owners who feel overwhelmed by the volume of automated calls they receive.
“I’ve had a person talk to me,” recounts Guthrie, ” and he says, ‘I’m a business person. I can’t not answer [the phone].”