Who we are

The Antitrust Coalition for Consumer Choice in Health Care includes employers, nurses, nurse-midwives and other nonphysician health care providers, health plans, and others involved in the purchase, management and delivery of health care services, who have united to oppose legislative efforts to weaken the application of federal antitrust laws to doctors. The Antitrust Coalition for Consumer Choice in Health Care opposes H.R. 3897 (sponsored by Reps. Barr (R-GA) and Conyers (D-MI)) because it would permit physicians to engage in collusive and cartel-like conduct to the detriment of consumers without fear of prosecution under antitrust laws. H.R. 3897, the "Health Care Antitrust Improvements Act of 2002," would essentially exempt doctors, dentists, pharmacists and other health care professionals from federal antitrust laws.

Why we oppose H.R. 3897

Instead of addressing the legitimate concerns of medical professionals regarding quality, H.R. 3897 is designed to legalize arrangements in which doctors could fix prices, boycott health plans and their enrollees, and agree to divvy up markets, all of which would disadvantage consumers. Such arrangements would increase health care costs to employers, employees, and the government; place nonphysician providers at an unfair competitive disadvantage; and nullify certain consumer protections common in many insurance contracts. Moreover, it would do nothing to improve health care quality, as current antitrust law already allows physicians to work together and with insurers to improve health care quality.

  H.R. 3897 would increase health insurance costs for employers and employees. In recent years, employers have faced steep hikes in their health insurance premiums. Firms increasingly have been forced to pass many of these costs directly to their workers. H.R. 3897 would make matters worse. Legalizing anticompetitive behavior would, for example, allow doctors in a market to combine into a single cartel and demand substantial fee increases, driving the cost of insuring workers still higher. This is not speculation. It is based on experience. Although it is currently illegal for health care professionals to engage in such behavior, many have. Over the years, the Federal Trade Commission (FTC) and the Antitrust Division of the Justice Department have encountered numerous incidents of price-fixing, boycotting, and anticompetitive behavior among physicians. Employers already are straining under the load of higher insurance premiums. Congress should not make a bad situation worse by legalizing anticompetitive behavior among doctors.

  H.R. 3897 would disadvantage nonphysician providers. If H.R. 3897 were to become law, groups of physicians could pressure health plans to accept unfair and exclusionary agreements at the expense of other health care professionals. Physicians would be much better positioned to force health plans to accept contractual terms that the physicians collectively negotiate, and these terms can be couched in an infinite number of ways that would unfairly disadvantage nonphysician providers. Such arrangements would hurt consumers in two ways: by increasing the cost of health care and restricting the ability of patients to receive care from nonphysician health care professionals.

  H.R. 3897 would not improve health care quality. In arguing that freeing doctors from federal antitrust laws would enable them to work collaboratively on improving health care quality, supporters ignore the reality that such collaboration is perfectly legal under current law. The 1996 FTC/DOJ Health Care Antitrust Guidelines permit providers to discuss collectively with health plans issues involving legitimate quality of care concerns or to bring such issues to the attention of the public. The guidelines also permit providers to organize networks and joint ventures to contract, or compete directly, with health plans. A recent FTC staff opinion permitted hundreds of physicians in Denver, CO to form a clinically integrated entity and allow this entity to jointly negotiate with health plans. Federal antitrust regulators have never brought an enforcement action aimed at providers who were attempting to communicate their views concerning patient care issues. Former FTC Chairman Robert Pitofsky has stated, "Every case we have brought - and I'm not aware of any private case, either - really related to doctors' income and not to patients' welfare."

  H.R. 3897 will increase physician fees. Since physicians already possess many vehicles that permit them to seriously collaborate on improving quality, it is clear that an antitrust exemption is intended solely for the purpose of increasing fees.

  H.R. 3897 would nullify certain consumer protections. Many health insurance contracts contain provisions that shield consumers against excessive charges. For example, many policies prohibit doctors from "balance billing" - that is, charging patients above and beyond what their insurance pays. Doctor cartels would pressure insurers to drop such consumer protections from their contract.

  H.R. 3897 would lead to higher cost for federal health programs. H.R. 3897 would lead to higher costs to Medicare, Medicaid, SCHIP and other programs for the elderly, poor and disabled. Although H.R. 3897 would not permit doctors to bargain collectively for higher fees in programs like Medicare and Medicaid, it would still result in increased costs to these and other public programs. The Congressional Budget Office (CBO) found that a related bill introduced in the 106th Congress (H.R. 1304) would have increased direct federal spending on federal health programs by $2.5 billion over 10 years, despite a similar provision with respect to public programs. This cost increase would occur because federal and state governments often contract with private insurers to extend coverage to seniors, children and people with disabilities. Since these plans would have to meet the fee demands of doctor cartels, government programs would face higher costs. These steeper costs would result, not from providing richer benefits to vulnerable populations, but from higher fees paid to providers.


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