Buttigieg's healthcare plan will hold hospitals accountable: Here's how

Pete Buttigieg, Democratic presidential candidate and mayor of South Bend, Ind., released a comprehensive healthcare plan Sept. 19 that would establish a public option and create checks and balances for all healthcare stakeholders, including hospitals and health systems.

The plan, which his campaign calls "Medicare for All Who Want It," would create a public option that exists alongside private insurance, leaving the door open for a single-payer plan "if private insurers are not able to offer something dramatically better." The plan would auto-enroll people eligible for free Medicaid coverage and those in non-Medicaid expansion states. It would also increase subsidies to buy public or private insurance and cap out-of-pocket costs for seniors with Medicare.

The detailed plan also includes provisions to standardize the insurance billing and claims process and hold payers accountable for improving price transparency. His campaign promised to release additional plans for drug pricing, innovation and equity in access to healthcare services and health outcomes in the coming weeks.

The Medicare for All Who Want It plan also includes a handful of provisions that seek to hold providers accountable for their role in increasing costs in the healthcare system. This is somewhat unique in the Democratic race, as many of the other candidates have noticeably avoided discussing the role of hospitals so far.

Here are five quick takeaways on how Mr. Buttigieg's plan would hold hospitals accountable for costs:

1. Providers, including physicians and ancillary service providers, would be required to bill in-network rates if they work at in-network hospitals.

2. Hospital out-of-network rates would be capped at twice the Medicare rate. The cap would be looser for critical access hospitals.

3. The plan would "strengthen" community benefit requirements for nonprofit hospitals, meaning Mr. Buttigieg would create standard definitions for what qualifies as community benefit and set baseline expectations. His plan also pledges to hold hospitals accountable if they do not meet this baseline.

4. The plan would increase funding for antitrust authorities to limit consolidation in the healthcare sector. It would authorize the Federal Trade Commission to intervene if nonprofit hospitals engage in anticompetitive behavior.

5. The plan would encourage the inclusion of price information in EHRs so physicians can discuss costs with patients at the point of care.

Read more about the plan here.

 

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