Expanding access to care, stabilizing the Affordable Care Act (ACA), and tackling the high cost of health care — including prescription drugs — will most likely dominate the health care agenda in Congress over the next two years, according to congressional leaders who spoke at an Atlantic Live briefing in Washington, D.C., on Feb. 27.
The briefing, titled Health Care + The New Congress, was sponsored by the AAMC and featured the chairs of the House and Senate committees with jurisdiction over health care — Sen. Lamar Alexander (R-TN) and Rep. Frank Pallone (D-NJ) — as well as Rep. Lauren Underwood (D-IL), a newly elected member of Congress who is also a registered nurse. AAMC President and CEO Darrell G. Kirch, MD, delivered remarks on the role that the nation’s medical schools and teaching hospitals play in the U.S. health care system.
While the speakers approached the conversation from different political perspectives, all agreed on the need for greater health care access and cost containment.
“A core value shared across my community is that health care is a human right,” said Underwood. “Even if someone is not interacting with the health care system, they understand the core principles, and right and wrong.”
Here are some top health care issues that are gaining significant traction in Congress.
Access to care
If lawmakers are going to improve access to health care, they’ve got their work cut out for them.
“The question of how you get to universal coverage is so polarizing,” said Grace-Marie Turner, president of the Galen Institute, a conservative public policy research organization, who also spoke at the briefing on a panel with Andy Slavitt, former Acting Administrator of the Centers for Medicare and Medicaid Services. “I think we really need to give people more choices and more control.”
Underwood said she is still trying to get a read on what her constituents want when it comes to health care — both in terms of Medicare and health care more generally.
“Where we are right now is trying to decide as a country, as activists, as advocates, what we want,” Underwood said. “Then we need to know how much it’s going to cost and how much we’re going to pay for it.”
Underwood told her own personal medical story at the briefing; the congresswoman was in elementary school when she was diagnosed with supraventricular tachycardia, an abnormally fast heart rate. As a result, she has become an advocate for those with pre-existing conditions.
“The health care experience is not partisan,” she said. “You get sick, you see a provider.”
The movement toward universal health care has expanded over the last several years, Slavitt said. “I think the public, over the last five years, has pretty significantly cemented its view that everyone should be able to have coverage.”
But there are barriers to care, including the doctor shortage that is only projected to get worse as baby boomers age, said Kirch.
“Think of the burden of illness that’s going to be growing as the boomers age,” Kirch said. “This is going to put a load on the health care system.”
Affordable Care Act stabilization
One of President Donald Trump’s campaign mantras was “repeal and replace” — and while that hasn’t happened, efforts to unravel certain components of the ACA, such as eliminating the individual mandate, continue to roll through the courts and Congress.
It is this “sabotage” that lawmakers are working to combat with a new ACA stabilization bill, said Pallone, chairman of the House Energy and Commerce Committee.
“The stabilization bill tries to stop the effort by the Trump administration to sell junk plans that discriminate against pre-existing conditions,” Pallone said. “Republicans are still trying to repeal the Affordable Care Act and are not doing things to make it work better.”
But Alexander, who chairs the Senate Committee on Health, Education, Labor, and Pensions (HELP), said he doesn’t think ACA repeal efforts are likely to gain traction in a divided Congress. “As a Republican legislator, I look at ‘where can I get a result?’” Alexander said. “We’ve proved over 8 years that’s hard to do on Obamacare.”
The Trump administration has issued rules, though, that run counter to some of the primary tenets of the ACA, in particular that all health plans cover pre-existing conditions and essential health benefits. In August 2018, the administration issued a rule that allows for the sale and renewal of short-term, limited duration plans that cover an initial period of less than 12 months and up to 36 months. These plans can charge higher premiums based on health status, exclude coverage for pre-existing conditions, and impose annual or lifetime limits.
But the focus should be on making necessary tweaks to the ACA rather than allowing for more limited plans, said Slavitt. For example, he noted, the ACA subsidy levels don’t extend high enough.
“The short-term, limited duration plan is not the plan people are seeking,” Slavitt said. “It essentially requires us to be smarter than the fine print. Where the solution is, is to very simply take the things that worked [in the ACA] and improve the things that didn’t work.”
Health care costs
Skyrocketing drug costs have become a top priority for both Republicans and Democrats. On Feb. 26, the Senate Finance Committee held a hearing that included executives from Pfizer, Merck, AbbVie, and other drug makers to discuss concerns about high drug prices and the impact on patients. President Trump has also pledged to lower these costs. Speakers at the briefing were hopeful that any measure to lower prices would be welcomed on both sides of the political aisle.
“The president’s job is to set the agenda,” said Alexander. “If he talks about reducing health care costs then the country will talk about it, [HHS Secretary Alex] Azar will talk about it, and we’ll get something done.”
The president’s plan takes aim at rebates, which many argue increase the out-of-pocket costs for patients.
“There’s a lot of discussion about modifying and even eliminating rebates,” Alexander said.
What’s known as “pay for delay” legislation aims to increase patients’ access to generic medications.
But it isn’t just drug prices emptying the pockets of patients — it’s the general price of health care.
“One thing the president understands is health care costs are the new gas prices,” Slavitt said. “People want to afford something they need. … The number one call to the American Cancer Society is ‘I can’t afford to have cancer.’”
Alexander said to expect a bipartisan bill on reducing health care costs by this summer.
How does academic medicine fit in?
Whatever happens on the policy front, academic medical centers are sure to be affected as one of the primary hubs for patient care, Kirch said.
“Only 5% of the hospitals in the United States are teaching hospitals, but they deliver a much greater percentage of the care,” Kirch said.
In fact, teaching hospitals deliver a quarter of the care to Medicaid patients and over 30% of care to the uninsured. Their burn units, neonatal intensive care units, and level one trauma centers also provide some of the most critical care, he said.
“They’re the places you’ll go when you’re really in trouble,” Kirch said.
And although there are still unsolved questions in health care policy, Kirch said he has great faith that the coming generations will be able to resolve them.
“I’ve visited all but eight of 152 U.S. medical schools, and at every one of them, I see the next generation being educated,” he said. “I have great confidence they’re going to be able to address a lot of the problems you’ve heard described today.”