How to Fix Healthcare: Certainty, Access, and Efficiency

Increase Market Certainty:

Guarantee continued payments for ACA subsidies that reduce enrollees’ cost-sharing

  • By removing the uncertainty caused by the Trump Administration, the nonpartisan Kaiser Family Foundation estimates that premiums would be 19% lower with guaranteed cost-sharing payments.

Create a permanent reinsurance program to offset the costs of especially expensive individuals.

  • By providing $15 billion/year to offset costs to health insurers who enroll a larger number of higher-cost, sicker beneficiaries, the Center for American Progress estimates that we could lower premiums by more than 14%.

Enforce the individual mandate and better advertise/fund open enrollment

  • President Trump’s first Executive Order in January 2017 relaxed the IRS’s enforcement of the individual mandate. He also pulled ads encouraging people to sign up for the remainder of open enrollment which likely contributed to a lower than anticipated enrollment.
  • We must fully enforce the individual mandate and increase funding for open enrollment marketing campaigns. As CoveredCA, California’s Healthcare Exchange noted, this is critical to ensure a good mix of people sign up for healthcare to balance the risk pool and help reduce premium increases for everyone.

Improve Consumer Access:

In the short term, create more affordable options for at-risk populations

  • For example, an option for older Americans aged 50-65 who often face the highest premiums, to buy into Medicare early.

Provide a public option for Americans in counties where a lack of choices is contributing to rising premiums

  • Americans in counties that have no plans, or only one plan, would be allowed to buy into a public option such as the state Medicaid program or the Federal Employee Health Benefits Program (FEHBP). The former has been suggested by CoveredCA, California’s Healthcare Exchange and the latter by the Center for American Progress.

In the long term, move towards a single-payer system

Increase Financial Efficiency:

Rein in health care costs by eliminating waste, fraud, and abuse

  • I have introduced legislation, H.R. 2066, the Protecting Integrity in Medicare Act, that will save Medicare $3.3 billion over 10 years according to CBO by closing the “In-Office Ancillary Services” (IOAS) exception loophole in the Stark Law that allows physicians to refer certain services in which they have a financial interest.
  • Last week, the Department of Justice charged the owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator and a physician’s assistant with conspiracy, obstruction, money laundering and health care fraud in connection with a $1 billion scheme involving numerous Miami-based health care providers.
  • Stopping the fraudulent practice of upcoding – billing for a more expensive service or procedure than was performed – could save billions. According to a 2015 Working Paper from the National Bureau of Economic Research, the government is paying an extra $2 billion a year to Medicare Advantage plans because of upcoding.

Allow for negotiation in drug prices

  • In his article “Bitter Pill: Why Medical Bills Are Killing Us,” author Steven Brill recommends that we amend patent laws and/or set price limits or profit-margin caps to reign in drug spending. According to his calculations, this would save Medicare more than $250 billion over 10 years.
  • The Committee for a Responsible Federal Budget has said that according to the nonpartisan Congressional Budget Office’s (CBO) analysis, giving the Secretary of Health and Human Services the authority to directly negotiate drug prices for Medicare, coupled with the authority to require brand-name drug manufacturers to lower the price of their drugs, could save Medicare Part D an average of $11 billion per year.

Tighten what Medicare pays for tests such as CT or MRI scans and cap what insurance companies can pay for them, coupled with medical-malpractice reform

  • Author Steven Brill suggests that providing safe-harbor defenses for doctors would discourage the need to order a CT scan whenever, “as one hospital administrator put it, someone in the emergency room says the word head”. Such practices are a huge contributor to overspending on outpatient costs.

Limit hospital administrator salaries to five or six times what the lowest-paid licensed physician gets for caring for patients there.

Author Steven Brill suggests that limiting hospital administrator salaries could stop the “self-fulfilling peer dynamic that [former CEO John] Gunn of [Memorial] Sloan Kettering [Cancer Center] cited when he explained, ‘We all use the same compensation cosolutants."