The Biden-Harris Administration is taking measures to combat fraudulent insurance plans that deceive consumers with false “in-network” designations or by misrepresenting their benefits. Their proposed rules would ensure income replacement “fixed indemnity” plans do not mimic comprehensive health coverage and safeguard consumers against unexpected bills.
Alice Miranda Ollstein from Politico, Anna Edney from Bloomberg News and Rachana Pradhan of KFF join KFF’s chief Washington correspondent Julie Rovner to discuss these critical topics.
Healthcare Access Expansion
In the US, many people lack affordable health coverage and it has been one of the main tenets of the ACA to ensure all citizens have coverage; yet even once this goal has been attained, we may still encounter barriers to providing high-quality healthcare and building healthier societies.
Not enough is done just to provide insurance: people must also be satisfied with their health care. This involves how well doctors and nurses treat them, having access to primary care physicians for preventative services and being able to afford medications needed.
The Biden-Harris Administration is taking steps to address these problems, including restricting junk insurance plans that offer no coverage and cracking down on deceptive practices by Medicare Advantage and drug plan providers. Furthermore, this administration is working towards expanding behavioral health care access for millions of Americans while at the same time encouraging states to strengthen their ability to assess provider network adequacy as well as update rules protecting against unexpected billing – measures which would both lower costs while protecting consumers against surprise bills that result from out-of-network care and limit unexpected charges associated with out-of-network care.
Prior to the COVID-19 pandemic, an aging population and geographic disparities drove demand for virtual care services. During its outbreak, telehealth was utilized to limit patient and practitioner exposure to COVID-19 virus as well as conserve personal protective equipment costs and improve clinical outcomes.
Today’s patients can benefit from various telehealth options available to them. For instance, high-risk infants can now see specialists without needing to travel thousands of miles or sit in cramped waiting rooms; doctors can exchange patient data and discuss treatment plans via videoconference; using telehealth can even reduce healthcare costs!
The American Medical Association is backing legislation that would permanently codify COVID-19-era telehealth flexibilities into law. Reintroduced this month, the Connect for Health Act currently boasts 60 cosponsors in the Senate and would remove Medicare’s distance restrictions, enabling patients to visit doctors from any location nationwide. It would also require CMS to publish quarterly information regarding use.
The American Medical Association (AMA) is actively supporting state and private sector efforts to expand telehealth availability; however, several barriers still remain; such as lack of broadband access in rural settings; regulations; as well as resources which hinder its growth.
Drug Pricing Reforms
President Biden’s Inflation Reduction Act and other recent laws allow Medicare to negotiate lower drug prices soon. Starting in 2023, the Centers for Medicare and Medicaid Services will begin selecting drugs to negotiate with manufacturers; agreed-upon prices will take effect in 2026.
Choices about which drugs to review and set price ceilings on can have dramatic ramifications for money savings, patient outcomes and innovation. For instance, restricting reviews to drugs which have long been available could address patent extensions through patenting minor changes to existing drugs or paying other manufacturers to delay entering the U.S market.
Consider whether the ceiling prices set by HHS will actually reduce drug costs. One approach would be to look at current or past prices in other countries as a reference point, however this would likely allow drugmakers to raise nominal-but not actual-prices and complicate HHS’ ability to know what its true cost was for each drug. A more viable approach is basing price limits on health benefits and treatment cost savings relative to price – an approach supported by experiences from other high-income nations.
Mental Health Emphasis
Mental health refers to emotional wellbeing that includes freedom from anxiety and disabling symptoms, the ability to form constructive relationships, and being able to cope with daily demands.
Although recent progress has been made, many Americans continue to face obstacles when accessing mental healthcare, partly because existing structures and systems often create an artificial separation between physical and behavioral healthcare. Furthermore, research conducted by Satcher Health Leadership Institute at Morehouse found that failure to receive mental healthcare costs patients far more than any money would spend on medical or other necessities.
To address these challenges, several states have taken steps to expand access to mental healthcare by lowering deductibles associated with these services, for instance Ohio and West Virginia have eliminated copay barriers for some behavioral health visits; however there remain other barriers that prevent patients from seeking treatment.
The federal government has been making efforts to remove these obstacles by making behavioral health a key priority of Medicaid, expanding telehealth services and creating rules to make treating beneficiaries in rural areas simpler for providers. Furthermore, through legislation such as Build Back Better Act and 2021 American Rescue Plan they have increased funding for behavioral health and community supports within Medicaid.
Public Health Preparedness Investments
Investment in public health preparedness is critical to mitigating future pandemic risks. This involves improving capacity to develop and deliver countermeasures such as vaccines, therapeutics and diagnostics against biological threats; increasing surveillance capabilities so as to quickly detect outbreaks as they happen; as well as strengthening surveillance infrastructure to detect outbreaks more quickly.
Jurisdictions are responsible for leading domestic responses to public health events, but are dependent on federal funding for their efforts. While CDC emergency funding has been vital in responding to the COVID-19 pandemic, its one-time allocation and specific focus prevent it from meeting infrastructure needs that might exist elsewhere in a jurisdiction.
Temporary nature of funding presents jurisdictions with unique challenges. Selected jurisdictions and stakeholders expressed concern that an increase in emergency-related spending while funding decreases thereafter may create an ongoing “boom and bust cycle,” making long-term public health investments harder to sustain.
Increase CDC’s base appropriation to allow investment in critical public health infrastructure, such as expanding workforce development programs and creating an information technology system capable of supporting response and prevention activities. Furthermore, invest in public health research and development programs which will accelerate time to market for new countermeasures like vaccines, pharmaceuticals, diagnostic tests, or personal protective equipment.
Value-Based Care Initiatives
Value-based care initiatives differ from traditional fee-for-service models by prioritizing patient outcomes and the efficiency of healthcare practices. They seek to align the interests of patients, providers, and health plans so that care will ultimately provide higher quality at lower cost.
As a result, both providers and patients will reap the rewards from this healthcare reform. Moving away from volume towards value should help improve key population health metrics and cut unnecessary costs, with 2023 healthcare practitioners expected to place greater emphasis on patient engagement with data analytics to identify specific healthcare needs within patient populations and deliver tailored care.
Though many providers have begun implementing value-based care initiatives, much more work needs to be done for these initiatives to reach their full potential. One of the key challenges involved with value-based care programs is incentivizing non-physician staff to participate in value-based care – these employees play an essential role in identifying patient needs and meeting them efficiently. By increasing employee participation organizations can maximize the benefits of value-based programs to provide improved clinical results while increasing revenue while avoiding unnecessary costs or penalties associated with overutilization costs or overutilization penalties.
Health Equity Measures
Health equity rests on the idea that everyone deserves equal access to healthcare services necessary for leading a healthy life, but this goal has yet to be fulfilled in reality due to various social conditions that limit this access based on factors like race, gender, income level and location.
Health reform initiatives aim to address these problems by targeting their root causes. This may involve efforts such as reducing health disparities and encouraging healthier lifestyle choices. Another component of health equity involves data collection and analysis – this initiative involves creating or strengthening infrastructures for data collection that collect and analyze variables such as race/ethnicity, language ability status disability status sexual orientation or gender identity variables.
Health equity is a top priority and core value at APHA, serving as its guiding principle and strategy for realizing their vision of a healthier nation. To further this effort, they have initiated the COVID-19 vaccination campaign to provide more equitable approaches and reach communities most affected by pandemic through frequent, open communications and working with trusted community health workers to share information; additionally they use community data to determine effective messaging.