Arkansas Center for Health Improvement

Fixes Still Needed

Article Date: 10/3/2017

Fixes still needed
Debate on health care not over

By Joseph W. Thompson, MD, MPH, president and CEO, Arkansas Center for Health Improvement; professor, UAMS Colleges of Medicine and Public Health

The demise of the latest Republican effort to repeal and replace the Affordable Care Act does not end the debate over the federal healthcare law, which has problems that still need to be addressed. Whether Congress steps up to the plate or, as the now-abandoned Graham-Cassidy bill proposed, hands the responsibility for crafting healthcare reforms to the states, changes are needed.

For reforms to be effective, they should be based on a set of underlying principles. The following five principles adopted by the Arkansas Center for Health Improvement Health Policy Board—an independent body representing a broad array of political, business, and healthcare perspectives—warrants consideration (below in bold):

  1. Comparable health care should be available regardless of age, income level, or geographic location.
    For citizens of the United States, the most affluent nation in the world, a basic set of healthcare benefits should be guaranteed. While the breadth of the existing standard benefits under the ACA may be too broad and could be reassessed, the availability of those benefits should be uniform.
  2. Coverage limits due to pre-existing conditions and premium pricing based on health conditions should be prohibited.
    Americans resonate with the reality that existing or future health conditions could affect them individually, and it is unlikely that we will return to previous insurance practices.
  3. Financing strategies must be actuarially sound and fiscally stable. Elimination of pre-existing-conditions requires high participation rates and strategies to mitigate adverse risk selection. To achieve coverage requirements necessary to support #2 above, one or more of the following should be incorporated:
    a. Participation requirement with a significant penalty for non-participation;
    b. Significant financial incentives for participation through tax credits; and/or
    c. Narrow enrollment windows and lock-out periods for non-participants
    There must be a significant enough “carrot-and-stick” approach to stabilize the risk by getting younger, healthier folks in the pool. Fundamentally, we must have more healthy people than sick people in the same risk pool for insurance to work. It’s politically easy to include principle No. 2, but it’s not fundamentally sound policy without principle No. 3.
  4. To ensure the health of the people of our state (and others) and safeguard economic stability, everyone must have access to appropriate healthcare coverage without unreasonable financial barriers.
    a. Evidence-based preventive clinical services should be included as essential coverage and not be subject to cost-sharing requirements.
    b. Care to manage chronic conditions and avoid future costs should not be subject to cost-sharing requirements; and
    c. Coverage for mental health and addiction care should have full parity with general medical care.
    Decisions around healthcare costs in traditional insurance coverage, and too often state and federal programs are made on an annual basis and based on year-to-year experiences. As a nation, we must take the long-term view of health. Investing in prevention, ensuring patient compliance in chronic care management, and addressing mental health needs are critical to avoid potential future costs and optimize the health of our citizens.
  5. Cost-containment should be achieved by optimizing value-based reimbursement strategies, price and quality transparency to support competition, and purchasing strategies to benefit consumers, including the pharmaceutical industry. 
    All of the current federal debate revolves around who should be covered, what benefits should be offered, and how coverage should be financed. Congress hasn’t even scratched the surface of even harder questions about the cost drivers in the healthcare industrial complex, and why Americans spend so much more but get such inferior outcomes from our healthcare system compared to other developed nations.

Changes to our healthcare system are needed but should involve everyone, not just the poor and the disabled. The adoption of a guiding set of principles will facilitate debate and safeguard outcomes in both federal and state decisions.

Thompson, Joseph. 2017. "Fixes still needed – Debate on health care not over." Arkansas Democrat-Gazette, September 30. Accessed October 3, 2017.

Arkansas Center for Health Improvement
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Little Rock, AR 72201