I 

111TH CONGRESS 

1ST SESSION H. R. 1493 

To ensure and foster continued patient safety and quality of care by exempting health care professionals from the Federal antitrust laws in their 

negotiations with health plans and health insurance issuers. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 12, 2009 

Mr. PAUL (for himself and Mr. PRICE of Georgia) introduced the following 

bill; which was referred to the Committee on the Judiciary 

A BILL 

To ensure and foster continued patient safety and quality 

of care by exempting health care professionals from the 

Federal antitrust laws in their negotiations with health 

plans and health insurance issuers. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Quality Health Care 

5 Coalition Act of 2009’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


rfrederick on PROD1PC67 with BILLS
2 

•HR 1493 IH

1 (1) According to a 2008 survey by the Henry 

2 J. Kaiser Family Foundation, 98 percent of Ameri3 cans who receive their health care through their em4 ployer are enrolled in some form of a managed 

5 health care plan, up from 27 percent in 1987. Seri6 ous questions have been raised about the quality of 

7 care patients are receiving under these plans. 

8 (2) Changes in the health care industry have 

9 led to an increased concentration of health care 

10 plans, including approximately 400 mergers in the 

11 last decade. This enhanced concentration has given 

12 health care plans significant leverage over health 

13 care providers and patients. 

14 (3) Antitrust laws which prohibit health care 

15 professionals from negotiating freely with health 

16 care plans infringe on the health care professionals’ 

17 constitutionally protected rights of freedom of asso18 ciation and contract. 

19 (4) Repealing Federal laws which prohibit med20 ical professionals from negotiating collectively with 

21 health care plans will create a more equal balance of 

22 negotiating power, will promote cooperation, and will 

23 enhance the quality of patient care. 

24 (5) Repealing Federal laws which prohibit med25 ical professionals from negotiating collectively with 


rfrederick on PROD1PC67 with BILLS
3 

•HR 1493 IH

1 health care plans will not change the professionals 

2 ethical duty to continue to provide medically nec3 essary care to their patients. 

4 SEC. 3. APPLICATION OF THE FEDERAL ANTITRUST LAWS 

5 TO HEALTH CARE PROFESSIONALS NEGOTI6 ATING WITH HEALTH PLANS. 

7 (a) IN GENERAL.—Any health care professionals who 

8 are engaged in negotiations with a health plan regarding 

9 the terms of any contract under which the professionals 

10 provide health care items or services for which benefits 

11 are provided under such plan shall, in connection with 

12 such negotiations, be exempt from the Federal antitrust 

13 laws. 

14 (b) LIMITATION.— 

15 (1) NO NEW RIGHT FOR COLLECTIVE CES16 SATION OF SERVICE.—The exemption provided in 

17 subsection (a) shall not confer any new right to par18 ticipate in any collective cessation of service to pa19 tients not already permitted by existing law. 

20 (2) NO CHANGE IN NATIONAL LABOR RELA21 TIONS ACT.—This section applies only to health care 

22 professionals excluded from the National Labor Re23 lations Act. Nothing in this section shall be con24 strued as changing or amending any provision of the 


rfrederick on PROD1PC67 with BILLS
4 

•HR 1493 IH

1 National Labor Relations Act, or as affecting the 

2 status of any group of persons under that Act. 

3 (c) NO APPLICATION TO FEDERAL PROGRAMS.— 

4 Nothing in this section shall apply to negotiations between 

5 health care professionals and health plans pertaining to 

6 benefits provided under any of the following: 

7 (1) The medicare program under title XVIII of 

8 the Social Security Act (42 U.S.C. 1395 et seq.). 

9 (2) The medicaid program under title XIX of 

10 the Social Security Act (42 U.S.C. 1396 et seq.). 

11 (3) The SCHIP program under title XXI of the 

12 Social Security Act (42 U.S.C. 1397aa et seq.). 

13 (4) Chapter 55 of title 10, United States Code 

14 (relating to medical and dental care for members of 

15 the uniformed services). 

16 (5) Chapter 17 of title 38, United States Code 

17 (relating to Veterans’ medical care). 

18 (6) Chapter 89 of title 5, United States Code 

19 (relating to the Federal employees’ health benefits 

20 program). 

21 (7) The Indian Health Care Improvement Act 

22 (25 U.S.C. 1601 et seq.). 

23 (d) DEFINITIONS.—For purposes of this section: 

24 (1) FEDERAL ANTITRUST LAWS.—The term 

25 ‘‘Federal antitrust laws’’ has the meaning the term 


rfrederick on PROD1PC67 with BILLS
5 

•HR 1493 IH

1 ‘‘antitrust laws’’ in subsection (a) of the first section 

2 of the Clayton Act (15 U.S.C. 12(a)), except that 

3 such term includes section 5 of the Federal Trade 

4 Commission Act (15 U.S.C. 45) to the extent such 

5 section 5 applies to unfair methods of competition. 

6 (2) HEALTH PLAN AND RELATED TERMS.— 

7 (A) IN GENERAL.—The term ‘‘health plan’’ 

8 means a group health plan or a health insur9 ance issuer that is offering health insurance 

10 coverage. 

11 (B) HEALTH INSURANCE COVERAGE; 

12 HEALTH INSURANCE ISSUER.—The terms 

13 ‘‘health insurance coverage’’ and ‘‘health insur14 ance issuer’’ have the meanings given such 

15 terms under paragraphs (1) and (2), respec16 tively, of section 733(b) of the Employee Retire17 ment Income Security Act of 1974 (29 U.S.C. 

18 1191b(b)). 

19 (C) GROUP HEALTH PLAN.—The term 

20 ‘‘group health plan’’ has the meaning given that 

21 term in section 733(a)(1) of the Employee Re22 tirement Income Security Act of 1974 (29 

23 U.S.C. 1191b(a)(1)). 

24 (3) HEALTH CARE PROFESSIONAL.—The term 

25 ‘‘health care professional’’ means an individual who 


rfrederick on PROD1PC67 with BILLS
6 

•HR 1493 IH

1 provides health care items or services, treatment, as2 sistance with activities of daily living, or medications 

3 to patients and who, to the extent required by State 

4 or Federal law, possesses specialized training that 

5 confers expertise in the provision of such items or 

6 services, treatment, assistance, or medications. 

Æ 


rfrederick on PROD1PC67 with BILLS