Healthy Competition for Better Care Act
- Bill Number
- H.R. 6248
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-21: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-05-22T08:07:33Z
AI-Generated Summary
Purpose of the Legislation
The Healthy Competition for Better Care Act (H.R. 6248) aims to promote competition in the healthcare market by prohibiting certain restrictive terms in contracts between health insurance plans and healthcare providers or networks. This is intended to prevent barriers that limit patients' access to higher-quality, lower-cost care options.
Key Provisions
- Prohibition on Anticompetitive Contract Terms: Health plans (including employer-sponsored and individual plans) and insurance issuers cannot enter agreements with "covered entities" (such as doctors, hospitals, provider networks, third-party administrators, or other service providers) that:
- Block the plan from guiding or incentivizing patients to use alternative providers not bound by the agreement (e.g., steering to cheaper or better options).
- Force the plan to contract with affiliates of the covered entity.
- Require the plan to set payment rates or terms for the covered entity's affiliates who are not part of the main agreement.
- Prevent other unrelated health plans from negotiating or paying lower rates for the same services.
- Exceptions: The steering restrictions do not apply to:
- Health Maintenance Organizations (HMOs; plans that use exclusive contracts with groups of doctors across specialties).
- Value-based arrangements (e.g., accountable care organizations, centers of excellence, or integrated health systems focused on quality and cost efficiency, as defined by federal guidance).
- Preservation of Flexibility: The law does not limit health plans' ability to design networks based on cost, quality, or performance incentives, such as tiered provider lists or pay-for-performance programs.
- Implementation Requirements:
- Federal agencies (Department of Health and Human Services, Labor, and Treasury) must issue regulations within one year of enactment to enforce these rules.
- Changes apply to contracts entered, amended, or renewed starting 18 months after enactment.
Significant Changes to Existing Law
- Amends three key federal laws:
- Public Health Service Act (PHSA): Adds a new subsection to Section 2799A-9, which previously focused on transparency in health plan pricing and provider information.
- Employee Retirement Income Security Act (ERISA): Updates Section 724 (governing employer health plans) by expanding its scope from transparency to also prohibit anticompetitive agreements; includes clerical updates to section headers and tables of contents.
- Internal Revenue Code (IRC): Modifies Section 9824 (applying to tax-favored health plans) similarly, broadening it to cover these prohibitions.
- These amendments build on existing transparency rules by introducing direct bans on specific contract practices, shifting focus from disclosure to active prevention of restrictive terms.
Potential Impacts
- On Citizens/Patients: Could increase access to affordable, high-quality care by allowing plans to steer patients to cost-effective providers and enabling more competitive pricing, potentially lowering premiums and out-of-pocket costs.
- On Government Agencies: Requires coordinated rulemaking by the Departments of Health and Human Services, Labor, and Treasury, increasing administrative workload to define and enforce exceptions (e.g., value-based networks).
- On Healthcare Industry: May disrupt existing provider contracts, encouraging renegotiation and fostering market competition, but could raise compliance costs for plans and providers.
- International Relations: No direct impacts mentioned, as the bill focuses on domestic U.S. health insurance markets.
Main Stakeholders Affected
- Health Insurance Issuers and Group Health Plans: Must revise contracts to avoid prohibited terms, gaining flexibility in network design but facing regulatory scrutiny.
- Healthcare Providers and Networks: Including doctors, hospitals, provider associations, and third-party administrators; may lose leverage in negotiations over affiliates or exclusive deals, potentially reducing their ability to bundle services.
- Patients and Beneficiaries: Primary beneficiaries through improved access and cost savings, though short-term disruptions in provider networks could affect care continuity.
- Employers (for Self-Insured Plans): Impacted via ERISA, as they sponsor many plans and may see changes in plan costs and options.
- Federal Agencies: HHS, Labor, and Treasury bear enforcement responsibilities.
Notable Legal, Constitutional, or Political Implications
- Legal: Aligns with antitrust principles (e.g., preventing anti-competitive practices under laws like the Sherman Act) by targeting contract terms that could be seen as restraining trade in healthcare. Exceptions for value-based models support ongoing shifts toward quality-focused care under laws like the Affordable Care Act. Potential for enforcement through civil penalties or contract invalidation, with regulations needed to clarify ambiguities (e.g., what qualifies as "steering").
- Constitutional: No apparent challenges; the bill regulates private contracts under Congress's commerce power (Article I, Section 8), similar to existing health insurance oversight.
- Political: Promotes bipartisan goals of reducing healthcare costs and enhancing competition, but may draw opposition from provider groups (e.g., hospitals) concerned about lost revenue, while appealing to insurers and consumer advocates. As an introduced bill referred to multiple committees, its passage could influence broader healthcare reform debates.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Arrington, Jodey C. [R-TX-19]
Cosponsors (5)
Rep. Davis, Donald G. [D-NC-1], Rep. Allen, Rick W. [R-GA-12], Rep. Edwards, Chuck [R-NC-11], Rep. Owens, Burgess [R-UT-4], Rep. Moore, Blake D. [R-UT-1]
Recent Actions
- 2025-11-21: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-11-21: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-11-21: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-11-21: Introduced in House
- 2025-11-21: Introduced in House
Bill Versions
- Healthy Competition for Better Care Act — issued 2025-11-21 — PDF (13 pages)