HR4002-119

What This Bill Does

The Patient Access to Higher Quality Health Care Act repeals three provisions from the Affordable Care Act and Health Care and Education Reconciliation Act that narrowed Medicare exceptions to the physician self-referral, or Stark Law, prohibition for hospitals. By restoring the amended provisions as if those sections had never been enacted, the bill would loosen federal limits on physician-owned hospitals, including restrictions on expansion and use of the whole-hospital or rural-provider exceptions that were tightened in 2010. Supporters generally view this as expanding patient access and competition; opponents generally see risk of self-referral, cherry-picking profitable patients, and higher Medicare spending. The text itself is a repeal-and-restoration bill rather than a new grant or coverage program.

Who Benefits and How

Physician-owned hospitals benefit because ACA limits on Medicare self-referral exceptions would be repealed. Physician investors benefit if restored Stark Law exceptions allow more ownership or expansion opportunities. Medicare patients seeking specialty hospitals benefit if more physician-owned facilities can operate or expand. Healthcare competition advocates benefit from removing federal barriers to physician-owned hospital growth.

Who Bears the Burden and How

Competing community hospitals face more competition from physician-owned hospitals. CMS Stark Law staff must administer restored rules as if the ACA restrictions had not been enacted. Federal taxpayers may bear higher Medicare spending if physician ownership increases referral-driven utilization. Hospital watchdog organizations may lose restrictions intended to limit conflicts of interest.

Key Provisions

• Repeals ACA section 6001 physician-owned hospital restrictions.
• Repeals ACA section 10601 related amendments.
• Repeals reconciliation-law section 1106 related amendments.
• Restores the affected Medicare self-referral provisions as if those sections had never been enacted.