Addressing Anti-Competitive Health Care Contract Clauses Act
The Addressing Anti-Competitive Health Care Contract Clauses Act would not itself change health care contracting rules. Instead, it directs the Government Accountability Office (GAO) to conduct a comprehensive study, in coordination with the Federal Trade Commission (FTC) and the Department of Justice (DOJ) Antitrust Division, on the use and effects of four types of anticompetitive contract clauses in agreements between health insurers and health care providers: anti-steering, anti-tiering, all-or-nothing, and gag clauses. The study would examine how these clauses influence market consolidation, prices paid by consumers, and access to care; catalog actions taken by the FTC/DOJ related to these clauses; assess the agencies’ resources and ability to enforce federal antitrust laws in this area; and, if needed, recommend legislative or administrative steps to bolster enforcement. A final report would be delivered to specified House and Senate committees within 18 months of enactment. In short, the bill seeks to quantify and evaluate whether certain contracting practices hinder competition in health care and to determine whether federal enforcement may need strengthening, with the results guiding potential future policy responses.
Key Points
- 1GAO study mandate, in coordination with FTC and DOJ, focused on four specific contract clauses: anti-steering, anti-tiering, all-or-nothing, and gag clauses.
- 2The study will assess effects on health care consolidation, consumer prices, and patient access to care.
- 3The study will compile a record of actions taken by the FTC and DOJ related to these clauses, whether direct or indirect.
- 4The study will evaluate whether the FTC and DOJ have the resources and authority to enforce federal antitrust laws as applied to these clauses, and will propose actions to increase those resources if needed.
- 5A formal report must be submitted to designated committees in both the House and Senate (specific committees listed for each chamber) within 18 months of enactment.
- 6All-or-nothing clause: requires either including all members of a health care provider in a network or entering into an affiliate contract as a condition of contracting with the provider.
- 7Anti-steering clause: restricts incentives or guidance that would lead enrollees to use a competing provider.
- 8Anti-tiering clause: restricts or dictates how providers are placed into tiers within a tiered network plan.
- 9Gag clause: restricts disclosure of price, cost, or quality information to various parties (e.g., enrollees, government entities, plan sponsors) and may limit sharing out-of-pocket cost information.