BLOG — Top 5 Federal Policy Priorities for Health Care Affordability

ACHP outlines five federal policies Congress and the Administration can enact to improve value in the American health care system.

by Ceci Connolly, Alliance of Community Health Plans President and CEO

The costs of the public health crisis underscore America’s long-standing need to pay for health care differently. When we prioritize preventive care and address social determinants of health, patient outcomes improve and costs go down. And when payers and providers work together, coordinating care and aligning payment incentives, value across the system improves even further.

Amid an ongoing pandemic — as our health care system flails under the stress of the last two years — we have the opportunity to make the big pivot our system needs. That takes real change, and the time is now. Large-scale, critical health care provisions are key. But as Congress continues debate and the uncertainty drones on, a series of pragmatic, stepwise changes can make a big impact. ACHP recommends policymakers focus on these 5 key areas to ensure affordable, high-quality coverage and care now and in the long run.

    1. Protect Medicare Advantage consumer benefits
      • Strong and growing bipartisan support from both chambers of Congress indicate the need to protect and strengthen the program.
      • The Centers for Medicare and Medicaid Services (CMS) must expand coverage to include audio-only encounters in risk adjustment during the pandemic to ensure patient acuity is accurately and appropriately documented and the needs of these patients continue to be met.
      • CMS should raise the bar on quality to include more accurate outcomes-based health metrics that help seniors compare MA plans.
    2. Commit to telehealth care delivery
      • Congress must pass legislation to make permanent current telehealth flexibilities — specifically removing geographic restrictions — and prioritize a consistent telehealth experience across all federal programs.
      • The Administration should incent value-based benefit design that supports telehealth by incorporating expanded virtual care delivery opportunities in value-based delivery models and demonstrations. 3. Commit to telehealth care delivery
    3. Stabilize access to affordable coverage 
      • Congress must make permanent the increased subsidies available to supplement health care coverage costs on the individual market.
      • The Administration must streamline the cumbersome Medicaid redetermination process and expand independent navigators and other enrollment assistance.
    4. Invest in equitable care 
      • Congress must advance the maternal health provisions included in the House-passed Build Back Better Act as well as bipartisan mental and behavioral health initiatives targeting improved access and care.
      • Federal programs should incent and standardize health data collection  to help us understand and analyze care gaps as well as inform targeted interventions to improve health equity.
    5. Lower the cost of prescription drugs
      • Congress and the Administration must move forward on bipartisan ideas that encourage innovation, improve transparency, stem anti-competitive practices and reform the broken drug patent system.
      • Congress should remove obstacles to generics reaching the market and allow formulary flexibility to improve affordability.

Learn how Washington can help inject value into the American health care system by listening to the latest episode of Healthy Dialogue, featuring Dr. Mandy Cohen from Aledade. Listen here