Examining Selected Proposals in “A Better Way to Fix Health Care”: Coverage Policy and Health Care Innovation (Part 2)
In our blog post on July 14, we talked about some of the provisions in the House Republican Health Care Task Force’s health reform proposal — entitled “A Better Way” — that NCHC believes would modernize and improve the Medicare program for beneficiaries and taxpayers alike. In later posts, we will turn a critical eye toward their plans for the children, seniors, and low-income adults who depend on Medicaid and CHIP. But today, we identify some elements of the Task Force’s coverage and innovation proposals that represent good starting points for future dialogue.
As an organization, NCHC has long been committed to finding common ground solutions to our health care challenges. And “A Better Way” does provide some room for future conversation. The Task Force report opens with the following quote: “Americans deserve an accessible and affordable health care system that promotes quality care and peace of mind. It should empower patients and support innovation.” We could not agree more with these goals. After all, the National Coalition on Health Care was established to support efforts for better and more affordable coverage for all Americans, and we too believe our health care system should focus on patient-centered, high quality health care.
But potential for common ground extends beyond the shared vision with which the report opens.
The House Republican Health Care Task Force goes on to embrace widely accepted consumer protections: coverage for dependents under age 26 on their parents’ plan, bans on lifetime and yearly coverage caps, protection from rescission or non-renewal of coverage and protection for patients with pre-existing conditions. The proposed safeguards are not as comprehensive as the ACA’s, but it is significant that, for all the disagreements over the 2010 law, there is now bipartisan agreement that federal policy should extend certain basic consumer protections to every American health care consumer. In another important step, “A Better Way” also endorses an advance-able, refundable tax credit to help those not on Medicaid or an affordable employer-based plan coverage. However, here as well, the House Republican approach is substantially different from the ACA’s and could prove substantially less generous for some.
NCHC also agrees with the Task Force on the importance of supporting and facilitating innovation. The report hits it on the mark when it suggests Healthcare Information Technology (HIT) policy must move “toward interoperability and exchange of information.” Payers, providers and American taxpayers all have made expensive investments in new technology intended to move our archaic paper-based system into the 21st Century. Unfortunately, silo-ed HIT systems still prevent providers from exchanging the information they need to coordinate and deliver the best care. We also agree on the importance of investments in medical research, though we would simultaneously stress the need to keep those treatments affordable and to support treatments which deliver better outcomes than existing therapies or treat patients at a lower cost.
Finally, NCHC shares the Task Force’s view that states can be effective laboratories for innovation. “A Better Way” backs a pair of medical liability reform ideas, safe harbors for following clinical practice guidelines and health courts, which may have the potential to lower costs and improve care. The proposed State Innovation Grants could also prove to be an intriguing pathway to promote broader state-level reform, especially if they are viewed as complements to existing Section 1115 and Section 1332 authorities which allow waivers of Medicaid and ACA provisions when states can present a better plan.
But one crucial area where we differ with the House Republican Health Care Task Force is this: NCHC recognizes that since 2010, the United States has already moved closer to realizing the very affordability, accessibility and quality goals with which ”A Better Way” begins. For all its faults, the Affordable Care Act has been integral to this undeniable progress: the uninsured rate at an all-time low of 9.1 percent (compared to 16.7 percent in 2013), improved financial protection for those who are insured, and slower-than-projected growth in Medicare spending.
In this, NCHC is far from alone.
Even respected House and Senate Republicans as well as conservative thought leaders like the Manhattan Institute’s Avik Roy and the American Enterprise Institute’s Thomas Miller are now advancing alternatives to complete repeal.
Instead of starting from scratch, we should focus our energy on what more can be done to build on recent coverage gains and, just as importantly, to make health care more affordable for consumers, employers and taxpayers. If that becomes our shared focus, “A Better Way” provides a great deal to talk about.
Of course, the “devil is in the details” as Washingtonians are fond of saying. But as we said last week, we look forward to working with House Republicans other members of Congress and the administration to find more common ground moving forward.
The National Coalition on Health Care (NCHC), the oldest and most diverse group working to achieve comprehensive health system reform, is a 501(c)(3) organization representing more than 80 participating organizations, including medical societies, businesses, unions, health care providers, faith-based associations, pension and health funds, insurers and groups representing consumers, patients, women, minorities and persons with disabilities. Member organizations collectively represent – as employees, members, or congregants – over 100 million Americans.
Some members of NCHC do not, or cannot, take positions either on specific legislation, strategies or on any policies outside their respective mission areas. However, all that can, do endorse broad policy positions in support of comprehensive health system change.
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