Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Expanding coverage and cutting health care costs: ideas for 2018

Cedric Dark, MD, MPH
Policy
January 8, 2018
30 Shares
Share
Tweet
Share

The controversy over health care reform often boils down to two issues: coverage and cost. The Affordable Care Act (ACA) made significant impact on the coverage issue, dropping the uninsured rate below 10 percent for the first time in the recorded history of the United States, covering 20+ million Americans in the 8 years since it was passed, and putting the United States on a reasonable path toward universal coverage.

Despite its name, however, the ACA has not made health care “affordable” for the vast majority of Americans. While the individual marketplace has offered reasonable, comprehensive coverage to nearly 10 million customers in the individual market, premiums continue to climb, deductibles continue to rise, and the opacity of health care pricing persists.

While liberals often focus on coverage and conservatives tend to care about costs, what can health reform advocates on either side of the political divide accomplish in 2018, tempered by the fact that the enemies of Obamacare control the White House and the Congress? In this — my annual policy prescription — I detail a few possible ways advocates can act to improve on coverage numbers while also suggesting a means to reduce the cost of care in the United States. It’s simple, really. Let’s ask voters and the states to bring coverage options to more Americans while asking the federal government to make meaningful changes designed to bring down the cost of health care.

The next step in coverage expansion should be the continued pursuit of Medicaid expansion in the remaining non-expansion states. Closing the Medicaid Gap in states that have yet to do so has the potential to cover over 2.3 million Americans. Last November, voters passed a ballot initiative in Maine bypassing an unwilling state legislature. Advocates on the ground in Idaho, Utah, and Nebraska are currently considering identical strategies. If successful in all three, 168,000 Americans could gain coverage. For Senators Orrin Hatch (Utah), Deb Fisher (Nebraska), and Bill Nelson (Florida) who will all be attempting to get re-elected this fall, their constituents should make minding the Medicaid Gap into a campaign issue.

Advocates in other states – especially Florida, Georgia, North Carolina, Tennessee, Texas, and Virginia – should inquire if enough interest exists in expanding Medicaid by ballot initiative there. Odds are it does, as opinion polling shows that Americans view the Medicaid program favorably (71 percent) and also think that it works well in their own state (64 percent) even among people residing in non-expansion states.

The other option advocates could pursue would be to open up their state Medicaid program as a “public option.” Nevada recently passed this type of plan through its legislature, although it was vetoed by the governor. A broader public option proposed by Hawaii Senator Brian Schatz and New Mexico Congressman Ben Ray Lujan would allow a Medicaid Public Option in every state. Polling shows favorable views of a public buy-in option (such as a Medicare buy-in) across the political spectrum. Because it remains unlikely that the current Congress and White House will act on these bills, advocates may choose instead to push for a state-by-state Medicaid buy-in wherever it is politically feasible.

Now, let’s discuss health care costs. For the rapid rise of health care costs to abate, two things need to occur. At the federal level, it is past time that the Medicare Prescription Drug Benefit (Part D) be allowed to create a formulary, exclude drugs that are expensive yet have cheaper alternatives, and to negotiate drug prices with the pharmaceutical industry. Albeit almost impossible with a president who reneged on his campaign promise and with a Secretary of Health and Human Services nominee who previously was on the payroll for Eli Lilly, there are bills in Congress that would allow Medicare to accomplish that task. Those bills — HR 4138 (sponsored by Elijah Cummings of Maryland) and S 2011 (sponsored by Bernie Sanders of Vermont) — could save taxpayers at least $230 billion over 10 years.

Additionally, advocates should encourage the adoption of all-payer claims databases. While states could get a large swathe of insurers to contribute information, due to a recent Supreme Court ruling, many self-funded (i.e., ERISA) health plans would be excluded. If the federal government will not waive that pre-emption, advocates should call on Congress to facilitate a federal all-payer claims database which would incorporate private insurance and public health program payments. The market faithful must agree that in order to make a health care market work, we require price transparency. The first step is knowing what prices are actually being paid for health care services across the country. The proprietary nature of health care transactions keeps health care costs opaque and permits excessive medical price inflation.

If advocates can rally behind various reforms in 2018 — grassroots efforts to expand Medicaid, an option for Americans to buy into their state Medicaid program, price negotiation and formulary creation for Medicare Part D, and robust support for all-payer claims databases across the country — we can accomplish the dual goals of expanding coverage and cutting health care costs.

Cedric Dark is founder and executive editor, Policy Prescriptions.

Image credit: Shutterstock.com

Prev

The non-difference between MDs and DOs

January 8, 2018 Kevin 5
…
Next

Learn about Clostridium difficile infection with a Medcomic

January 8, 2018 Kevin 0
…

Tagged as: Public Health & Policy, Washington Watch

Post navigation

< Previous Post
The non-difference between MDs and DOs
Next Post >
Learn about Clostridium difficile infection with a Medcomic

More by Cedric Dark, MD, MPH

  • A theological answer to our health care crisis

    Cedric Dark, MD, MPH
  • A path to universal health coverage in America

    Cedric Dark, MD, MPH
  • Why this physician divested from a firearms maker

    Cedric Dark, MD, MPH

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • America leads the world in high tech care and health care costs

    Mark Kelley, MD
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • How inflation fueled health care costs

    Ricardo Chujutalli, MD, MBA and Jessica Yoong
  • 3 reasons why health care costs are rising

    Samuel Falkson
  • Will Buffet, Bezos, and Dimon be able to control health care costs?

    Peter F. Nichol, MD, PhD

More in Policy

  • Pediatricians grapple with guns in America, from Band-Aids to bullets

    Tasia Isbell, MD, MPH
  • Health care wins, losses, and lessons

    Robert Pearl, MD
  • Maximizing care amidst provider shortages: the power of measurement-based care

    Tom Zaubler, MD
  • Unveiling excessive medical billing and greed

    Amol Saxena, DPM, MPH
  • Chronic health issues and homelessness

    Michele Luckenbaugh
  • The impact of certificate of need laws on rural health care

    Jaimie Cavanaugh, JD and Daryl James
  • Most Popular

  • Past Week

    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • When physicians are disrespected [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • When physicians are disrespected [PODCAST]

      The Podcast by KevinMD | Podcast
    • Addressing dual diagnosis needs in addiction treatment

      Susan Hertz Berrick, EdD | Conditions
    • The essence of health narratives, including poetry

      Arthur Lazarus, MD, MBA | Physician
    • Discover the power of patience

      Diane W. Shannon, MD, MPH | Physician
    • Doctors rediscover joy in practicing medicine, on their own terms

      Kim Downey, PT | Physician
    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Novavax's Updated COVID Shot Authorized by FDA
  • SBRT Noninferior to Conventional RT for Intermediate-Risk Prostate Cancer
  • Mixed Bag for Early Metformin in Gestational Diabetes
  • FDA Advisors to Consider DFMO Maintenance for High-Risk Neuroblastoma in Kids
  • Adding Tirzepatide to Basal Insulin Cuts HbA1c in Poorly Controlled T2D

Meeting Coverage

  • SBRT Noninferior to Conventional RT for Intermediate-Risk Prostate Cancer
  • Mixed Bag for Early Metformin in Gestational Diabetes
  • Adding Tirzepatide to Basal Insulin Cuts HbA1c in Poorly Controlled T2D
  • Low Relapse Rates With Twice-Yearly Schizophrenia Treatment
  • Menopause Can Negatively Affect Women's Careers
  • Most Popular

  • Past Week

    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • When physicians are disrespected [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • When physicians are disrespected [PODCAST]

      The Podcast by KevinMD | Podcast
    • Addressing dual diagnosis needs in addiction treatment

      Susan Hertz Berrick, EdD | Conditions
    • The essence of health narratives, including poetry

      Arthur Lazarus, MD, MBA | Physician
    • Discover the power of patience

      Diane W. Shannon, MD, MPH | Physician
    • Doctors rediscover joy in practicing medicine, on their own terms

      Kim Downey, PT | Physician
    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Expanding coverage and cutting health care costs: ideas for 2018
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...