H.R.4002 - Patient Access to Higher Quality Health Care Act of 2025 (119th Congress)
Summary
H.R.4002, the Patient Access to Higher Quality Health Care Act of 2025, aims to repeal specific sections of the Patient Protection and Affordable Care Act (ACA) and the Health Care and Education Reconciliation Act of 2010. These sections relate to the Medicare exception to the prohibition on certain physician referrals for hospitals. The bill seeks to restore the provisions of law as they existed before these ACA amendments.
Essentially, this bill targets the Stark Law, which generally prohibits physicians from referring patients to entities with which they have a financial relationship. The ACA modified exceptions to this law, and this bill seeks to undo those modifications.
The bill was introduced in the House of Representatives and referred to the Committees on Energy and Commerce and Ways and Means.
Expected Effects
The primary effect of this bill, if enacted, would be to reinstate the pre-ACA rules regarding physician referrals to hospitals under Medicare. This could potentially lead to changes in how hospitals and physicians structure their relationships and how healthcare services are delivered.
It could also affect the financial arrangements between physicians and hospitals, potentially influencing the volume and type of referrals made. The repeal could alter the competitive landscape within the healthcare industry.
Ultimately, the impact on patients is uncertain and would depend on how healthcare providers respond to the restored regulations.
Potential Benefits
- Could reduce administrative burdens and compliance costs for hospitals and physician practices, potentially leading to more efficient healthcare delivery.
- May allow for greater flexibility in structuring collaborative arrangements between hospitals and physicians, potentially fostering innovation in healthcare services.
- Could restore certain referral patterns that were disrupted by the ACA, potentially benefiting patients who had established relationships with specific providers.
- Might lead to increased investment in certain healthcare facilities if the referral rules are relaxed.
- Could address unintended consequences of the ACA's changes to the Stark Law exceptions.
Potential Disadvantages
- Could increase the potential for self-referral arrangements that may lead to overutilization of services and higher healthcare costs.
- May reduce competition among healthcare providers if certain entities gain an unfair advantage through relaxed referral rules.
- Could undermine efforts to promote value-based care and coordinated care models that rely on objective referrals.
- Might disproportionately benefit larger healthcare systems that have the resources to navigate complex referral arrangements.
- Could potentially compromise patient choice if referrals are driven by financial incentives rather than medical necessity.
Constitutional Alignment
The bill's constitutional alignment is primarily rooted in Congress's power to legislate on matters related to Medicare and healthcare under the Commerce Clause (Article I, Section 8). The Constitution grants Congress broad authority to regulate interstate commerce, which includes the healthcare industry.
There are no apparent violations of individual rights or liberties as the bill focuses on regulatory changes within the healthcare system. The bill does not appear to infringe upon any specific constitutional amendments.
However, the debate surrounding the bill could raise questions about the role of the federal government in healthcare regulation and the balance of power between the federal government and the states.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).