Congress should give up the latest attempt to revive fundamentally flawed ACA repeal legislation. It is time to refocus on ways to actually slow the growth of health costs rather than simply shifting them to patients and states.
To be sure, a fresh start must begin with immediate steps to preserve health coverage—by funding cost-sharing reductions and extending the Children’s Health Insurance Program. But it should not end there.
Below, we map out five policy directions that actually address our fundamental health care challenge: the growing unaffordability of health care goods and services.
Support State-Led Health Reform
Governors of all political stripes have called for more rational approaches to state waiver requests under ACA’s Section 1332 and Medicaid’s Section 1115. Without the specter of deep cuts in federal funding, substantial policy progress should be possible here. As long as basic guardrails ensuring public input and protecting coverage, benefits, and affordability remain in place, federal policymakers should aggressively support state initiatives that extend coverage, reform delivery and payment across payer types, and shift long-term care services away from institutional settings.
Free Up Medicare Providers and Plans to Battle Chronic Disease
The best Medicare Advantage (MA) plans and the best providers (in the Next Gen ACO program and elsewhere) are delivering on the promise of better outcomes at lower costs – by improving care for high-cost, high-need beneficiaries. But restrictions on home-based care, telehealth and remote patient monitoring technologies, and non-medical interventions are holding back success. Building on the Senate Finance Committee’s CHRONIC Care Act and recent House legislation, Congress should quickly send Medicare chronic care legislation to the Administration and then work with them to target other barriers to reform.
Invest in Primary Care
America devotes about half as much of its health spending to primary care as other nations – and it’s helping drive up our overall costs. Fixing this imbalance will require long-term shifts in how we deliver and pay for care. But in coming weeks, Congress can start by extending expiring funding for Federally Qualified Health Centers, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education Program.
Invest in Public Health
America needs to recommit to addressing the factors that are driving health costs up. Investments upstream and a focus on the broader determinants of health could reduce the need for medical services in the first place. For example, addressing the causes of costly conditions such as opioid abuse, asthma, hypertension, and heart disease early on could not only reduce overall health costs, but improve our country’s overall health and well-being.
Advance Market-Based Solutions to High Drug Prices
The fastest growing category of health care expenditures today is prescription drugs – driven by unsustainable industry pricing practices. Fixing our broken pharmaceutical marketplace demands the same market solutions needed in any functioning market: transparency, competition, and value. The bipartisan CREATES Act, which bars brand name manufacturers from denying samples to potential generic competitors, would be a good start.
Of course, these ideas aren’t the only paths to progress. But any serious health reform effort must address cost and affordability. The need is urgent and stakes are high.