Five Concrete Steps Congress Can Implement to Improve Healthcare Access and Affordability

Unpacking Healthcare costs: Why Congress Must Act for Affordable Care

The current healthcare landscape is a complex web of rising costs and convoluted policies,leaving millions of Americans struggling to afford quality care. While the Affordable Care Act (ACA) brought critically importent expansions, its tax credits are set to expire, threatening to push coverage out of reach for many. This article explores key areas where legislative action is crucial to curb health care expenses,improve patient access,and ensure the integrity of existing protections.

Tackling Hospital Price Inflation: The Case for Site-Neutral Reforms

Hospital prices have become a major driver of escalating healthcare costs, with prices jumping on average by a staggering 14%. the impact of limited competition is particularly stark: in markets with no hospital competition, prices are a significant 12% higher than in areas with more choice. This disparity highlights a systemic issue where a lack of competition allows for unchecked price increases.site-neutral payment reform offers a powerful solution to this problem. By ensuring that Medicare pays the same rate for services regardless of where they are performed (e.g., in a hospital or an self-reliant clinic), this reform would level the playing field, reduce out-of-pocket costs for patients, and ultimately lower insurance premiums. The Congressional Budget Office (CBO) estimates that such reforms coudl save over $170 billion in federal spending over ten years. It is imperative that Congress holds hospital systems accountable for this price inflation and takes action to provide patients with better access to affordable, high-quality care.

Reclaiming the Promise of the No Surprises act: Cracking Down on Private Equity Misuse

The No Surprises Act was enacted with the laudable goal of protecting patients from unexpected and frequently enough exorbitant out-of-network medical bills. However, a disturbing trend has emerged where certain private equity-backed providers and arbitration middlemen are systematically exploiting the law’s independent dispute resolution (IDR) process. This manipulation is designed to extract maximum payments, frequently exceeding even the original billed charges, effectively undermining the Act’s protective intent.

To restore the No Surprises Act to its original purpose, Congress, in collaboration with the governance, must address these flaws in the arbitration process. Key steps include:

Blocking ineligible claims and disputes from entering the arbitration pipeline. Establishing clear and robust processes to correct or reject invalid claims, preventing frivolous arguments.
Implementing rigorous auditing of IDR entities and holding parties accountable for submitting false claims.
Requiring stronger training and oversight of arbitrators to ensure impartiality and adherence to the law’s spirit.
Releasing obvious data on arbitration decisions and identified patterns of abuse to foster accountability and deter further manipulation.

These crucial fixes will ensure that the No Surprises Act truly shields patients from costly and unfair charges from out-of-network providers.

Safeguarding Medicare advantage and Employer-sponsored Insurance: pillars of Affordable Care

For millions of Americans, Medicare Advantage (MA) and employer-sponsored insurance are vital lifelines to quality healthcare. Nearly 35 million seniors and individuals with disabilities opt for Medicare Advantage becuase it consistently delivers better services, improved access to care, and greater value compared to conventional fee-for-service Medicare. It is essential that Congress prioritizes policies that strengthen this successful program and resist measures like the No UPCODE Act,which would inevitably lead to higher costs for seniors.

Similarly, protecting employer-provided coverage is paramount. businesses of all sizes offer complete health benefits to their employees and families,providing affordable,private health insurance to the majority of Americans – nearly 180 million people. Proposals to eliminate or cap the employer tax exclusion would function as significant tax increases on working Americans across all income levels.Such changes risk forcing millions to lose their health coverage, pushing them onto more expensive public programs and burdening taxpayers. Congress should instead focus on proposals that support and fortify the proven framework of the Employee Retirement Income Security Act (ERISA), which underpins the employer-sponsored system.

The Path Forward: A Call to Action for Congress

Making healthcare simpler and more affordable for millions of Americans requires decisive action from Congress. By prioritizing these critical areas, lawmakers can create a more equitable and sustainable healthcare system:

Extend ACA Tax Credits: Ensure continued affordability for millions.
Enact Site-Neutral Reforms: Curb hospital price inflation and reduce patient costs.
Lower Drug Costs: Address the skyrocketing price of prescription medications.
Strengthen the No Surprises Act: Protect patients from predatory billing practices.
Protect Access to Coverage: Safeguard vital programs like Medicare Advantage and employer-sponsored insurance.

The time for deliberation is over.Congress must act now to deliver on the promise of affordable, accessible, and high-quality healthcare for all Americans.

How would fully expanding Medicaid in all states impact uncompensated care costs for hospitals?

Expanding Medicaid and the Affordable Care Act (ACA) Subsidies

One of the most impactful steps Congress can take to instantly improve healthcare access is to fully expand medicaid in all remaining states. Currently, twelve states have not adopted the Medicaid expansion under the ACA. This leaves millions of low-income Americans without access to affordable health insurance.

Financial Incentives: Offer increased federal matching funds to incentivize holdout states.

ACA Subsidy Enhancement: Permanently extend and enhance the ACA’s premium tax credits. These subsidies help individuals and families afford health coverage through the marketplace exchanges. Increasing subsidy amounts, particularly for those with moderate incomes, can significantly lower monthly premiums.

The Impact: Expanding coverage reduces uncompensated care costs for hospitals, improves public health outcomes, and boosts economic security for vulnerable populations. This directly addresses affordable healthcare concerns.

Negotiating Prescription Drug Prices

The high cost of prescription drugs is a major driver of rising healthcare expenses. Allowing Medicare to negotiate drug prices, a long-debated policy, would generate substantial savings.

H.R. 3: The Elijah E. Cummings Lower Drug Costs Now act (though previously stalled) provides a framework for negotiation. Reintroducing and passing similar legislation is crucial.

International Price Indexing: Tie drug prices to those paid in other developed countries, where prices are often significantly lower.

Generic Drug Access: Streamline the approval process for generic drugs and biosimilars to increase competition and lower costs.

Real-World Example: The Veterans Affairs (VA) system already negotiates drug prices, resulting in significantly lower costs compared to medicare. This demonstrates the feasibility and potential savings of broader negotiation authority.

Investing in Primary and Preventative Care

Shifting the focus from reactive treatment to proactive primary care and preventative healthcare is essential for long-term cost control and improved health outcomes. As the WHO defines, primary health care addresses the majority of a person’s health needs throughout their lifetime.

Funding Community Health Centers: Increase funding for Federally Qualified Health Centers (FQHCs), which provide comprehensive primary care services in underserved communities.

Workforce Development: Invest in training and recruitment programs to address the shortage of primary care physicians, nurses, and other healthcare professionals.

Preventative Services Coverage: Ensure all health insurance plans fully cover recommended preventative services, such as vaccinations, screenings, and wellness visits, without cost-sharing.

Telehealth Expansion: Permanently expand access to telehealth services,particularly in rural and underserved areas,to improve access to care and reduce costs.

Addressing Healthcare consolidation and Anti-Competitive practices

Hospital mergers and acquisitions have led to increased market concentration, reducing competition and driving up prices. Congress needs to strengthen antitrust enforcement in the healthcare industry.

increased Scrutiny of Mergers: Implement stricter reviews of hospital mergers and acquisitions to prevent monopolies and ensure they do not lead to higher prices or reduced quality of care.

Transparency in Pricing: Require hospitals and insurers to publicly disclose prices for common procedures and services. This transparency empowers consumers to make informed decisions and promotes competition.

Anti-payer Practices: Prohibit anti-competitive practices by insurers, such as “gag clauses” that prevent doctors from discussing treatment options with patients.

Case Study: Research consistently shows that hospital mergers often lead to higher prices without corresponding improvements in quality.

Strengthening Mental Healthcare Access and Integration

Mental health is an integral part of overall health, yet access to mental healthcare remains a significant challenge. Congress must prioritize expanding access to affordable and quality mental health services.

Mental Health Parity Enforcement: Strengthen enforcement of the mental Health Parity and Addiction Equity Act to ensure that mental health and substance use disorder benefits are covered at the same level as physical health benefits.

Integration with Primary Care: Promote the integration of mental healthcare into primary care settings to improve access and reduce stigma.

Tele-Mental Health: Expand access to tele-mental health services, particularly in rural and underserved areas.

Workforce expansion: Invest in training and recruitment programs to address the shortage of mental health professionals.

Benefits: Early intervention and access to mental healthcare can prevent crises,reduce healthcare costs,and improve overall well-being.