Healthcare stakeholders and think tanks have responded to a Capitol Hill call for how best to lower healthcare costs. The Brookings Institution and the American Enterprise Institute offered a bipartisan response the groups said would both slow the race of healthcare costs and win support across the political spectrum.
The duo suggested multiple ideas, including limiting the tax exclusion for employer-sponsored health insurance, enforcing antitrust measures for healthcare consolidation, repealing willing provider and certificate of need laws, legislating against surprise billing, expanding site-neutral payments and increasing Medicare fee schedule rates for evaluation and management services.
Meanwhile, the American Medical Group Association advised Congress to move to a value-based care system, decrease administrative burdens, promote price transparency and encourage patient engagement and accountability. The American Benefits Council, a group that advocates for employer-sponsored health plans, suggested improving employers' access to health data, using uniform quality measures, modernizing health savings accounts and reducing incentives for provider consolidation, including expanded site-neutral payment reform.
The recommendations come after a December request from Sen. Lamar Alexander, R-Tenn., who chairs the Senate Committee on Health, Education, Labor and Pensions. Alexander's request followed failed Republican efforts to repeal and replace the Affordable Care Act in 2017.
Since the repeal effort's failure, Democrats took control of the House. Republicans still control the Senate. The situation means bipartisan health reforms are warranted to have any shot of getting healthcare legislation passed before 2021 — especially given the current turmoil over Medicare for all.
With that in mind, Alexander is hoping to find commonality.
One proposal found in multiple recommendations is to strengthen surprise billing laws. Surprise bills lead to higher out-of-pocket bills for patients and can result in uncompensated care for hospitals. At the very least, surprise bills require hospitals and providers to chase down payments from patients.
Lawmakers on Capitol Hill and President Donald Trump have spoken out about surprise bills, so potential legislation does stand a chance. But leaders in Congress will have to create a plan that tackles the problem without further hurting providers and limiting pain for payers. "The first place to deal with it is for the hospitals and doctors and insurance companies to get together and end the practice," Alexander told reporters recently. "And if they don't, Congress will do it for them."
Another provision mentioned in multiple proposals deals with moving faster to a value-based care system. CMS is testing value-based care, but the agency wants providers to take on risk sooner. Most healthcare experts trumpet value-based care in theory, but providers push back taking on more risk.
Payers are also divided on what value-based system works best. Those kinds of issues will need to be worked out if value-based care is to become the norm.