Healthy Competition for Better Care Act

This bill seeks to eliminate anticompetitive practices in health care by amending the Public Health Service Act, ERISA, and the Internal Revenue Code. Its primary goal is to foster competition and improve access to more affordable and higher-quality care for consumers. The legislation specifically prohibits certain contractual terms between health plans and "covered entities," which include providers, networks, and third-party administrators. These banned terms include those that restrict health plans from directing or steering patients to other providers or offering incentives for specific providers. It also forbids clauses that compel health plans to contract with a covered entity's affiliates or agree to their payment rates, or that prevent other plans from negotiating lower rates for services. However, the bill includes important exceptions to these prohibitions. These exceptions apply to Health Maintenance Organizations (HMOs) that operate primarily through exclusive contracts with multi-specialty physician groups. It also exempts various value-based network arrangements , such as accountable care organizations, exclusive provider networks, and centers of excellence, recognizing their role in promoting coordinated care. Furthermore, the bill provides a State grandfathering option , allowing state authorities to permit certain existing agreements, executed between June 2019 and December 2020, to continue for up to 10 years if they do not significantly lessen competition. The Secretaries of Health and Human Services, Labor, and the Treasury are mandated to issue regulations within one year of enactment, and the provisions will apply to contracts entered into, amended, or renewed 18 months after the bill becomes law.