The Senate just released a major bi-partisan proposal to tweak several significant health policy challenges. The headline proposal is eliminating surprise billing which occurs when a patient goes to an in-network provider and then gets an out of network bill for a specific set of services that they may or may not have consented to.
However, the data geek in me is hyper excited about Section 303. Here, the Senate is proposing a national all payers claims database (APCD).
‘‘(a) IN GENERAL.—The Secretary, in consultation with the Secretary of Health and Human Services, not later than 6 months after the date of enactment of the Lower Health Care Costs Act, shall have in effect a contract with a nonprofit entity to support the establishment
and maintenance of a database that receives and utilizes health care claims information and related information and issues reports that are available to the public and authorized users, and are submitted to the Department of Labor.
I am truly geeking out about the requirement that self-insured plans which are regulated by the 1974 Employee Retirement Income Security Act (ERISA) will be required to submit de-identified data. ERISA has a strong pre-emption of state laws for self-insured plans. The Supreme Court ruled in 2016 that ERISA pre-emption meant that states could not require self-insured plans to send data to state based APCD. Self-insured plans make up the overwhelming majority of large employer groups so missing this data means any database is wildly and non-randomly incomplete which limits the research value of these databases.
From a policy side, the argument for an exhaustive and near complete APCD is that it will compress price variation and allow for better/smarter negotiations and explicit trade-offs in designing benefits and networks. That should be cost saving. It will also allow for far better research that has far more generalizability with fewer caveats.
This is a big deal if signed into law and it should start providing good insight in a few years if it is enacted. I know I have at least one 2020 research idea where a complete APCD would be absolutely wonderful as the self-insured universe faces a different set of rules and incentives than the ACA universe for a particular problem I want to poke at. I know other researchers have similar projects in their want to do list too.