Every American deserves access to affordable coverage and care. But health care prices continue to escalate year after year, making coverage and care less accessible for everyone. This challenge can be tied directly to less competitive health care markets.
Health insurance providers know that market-based solutions that strengthen competition will improve affordability and access for everyone. And there is good news: Several federal and state policy improvements have been made over the last year that can and will help drive more competition and less costly care for patients that need it.
More Telehealth Access
When patients have access to virtual care, it provides a more competitive landscape that offers them more control and choice on when and where they get care. Telehealth is also generally more affordable. Patients who use telehealth to see providers during urgent care visits were able to avoid unnecessary tests, saving an average of $118 for each visit.
During the COVID-19 emergency, Congress passed temporary flexibilities that allowed virtual care to thrive. Instead of letting these flexibilities expire in late 2022, Congress extended the provisions to 2025. AHIP strongly supported this extension, and we are continuing to advocate for these flexibilities to become permanent.
Extended Home Care Programs
Another pandemic-era practice, called hospital at home, enabled facilities to provide hospital-level care in the home for a range of conditions such as chronic obstructive pulmonary disease and congestive heart failure. These programs boosted patient access and choice. While the waiver that allows these programs to thrive was set to expire on May 11, 2023, the federal government agreed to extend the program until 2025, which gives more time for insurance providers to pilot test alternative payment models designed to encourage home-based acute care.
There’s also growing attention for policies that enable greater use of home dialysis. The administration released a regulatory agenda that includes a future proposed rule to modernize conditions for coverage policies, which could pave the way for their implementation and more competitive care choices for patients. AHIP is continuing to collaborate with the Innovate Kidney Care coalition to advocate for progress.
New Scrutiny for Health Investors
There is a new, surging level of interest from some private equity firms in acquiring specialty medical providers and hospitals — and potentially for turning a quick profit. The trend has raised questions and concerns about the threat of anticompetitive practices. More transparency, oversight, and reforms are needed to remove some of the incentives and opportunities of certain private equity firms to exploit patients for profit.
This year the Centers for Medicare & Medicaid Services recognized the importance of disclosure of private equity in health care — specifically in nursing homes. The agency proposed a new rule, that if made permanent, would require nursing homes to report ownership and management information, exposing private equity investors or real estate investment trusts. AHIP commended HHS recently as it began, for the first time, releasing ownership information on more than 6,000 Medicare-certified hospices and 11,000 home health agencies.
Lower Costs of Care, No Matter Where You Get it
Health treatments and therapies shouldn’t cost more because of the type of facility in which you receive it. Hospitals and physicians stifle competition and often charge more (118% and 23% respectively) for the same treatment and care compared to specialty pharmacies for the same exact drugs.
The 118th Congress has also shown bipartisan interest in this area through a series of hearings in the Energy and Commerce Committee and through the release of draft legislation that aims to combat these payment inequities.
There are also promising developments at the state level.
- In Indiana, lawmakers last month enacted legislation that requires physicians to be paid at the rate for administering treatments or care, regardless of the care setting. It also establishes a task force for health care affordability – that can make recommendations concerning market concentration for health care providers – which helps grow the kind of competition that drives lower costs of care.
- In Washington, the state budget this year also includes more money for the insurance commissioner and attorney general to find new ways to regulate anticompetitive behaviors, such as these payment inequities, increasing hospital consolidation, and antitrust issues.
Cracking Down on Drug Pricing Schemes
There’s also good news from federal courts when it comes to boosting competition in health care. In January the Supreme Court shot down a proposal by drugmaker Pfizer for programs in which it subsidizes the purchase of its own drugs to be exempt from a federal law called the Anti-Kickback Statute. The law is designed to stop drugmakers from engaging in anticompetitive practices designed to increase the number of patients buying their specific drugs — and then leaving taxpayers and patients to pick up the tab in the form of higher federal spending and health insurance premiums. AHIP submitted an amicus brief during the case supporting HHS and highlighting other lawful ways Big Pharma could, if it chose to, make medications more affordable for patients.
A Healthier Future
By improving competition in key areas of our health care system, we can improve affordability and access for everyone. Health insurance providers are committed to working with federal and state officials and other health care leaders to take decisive action, and to advocate for the laws, regulations, and needed enforcement. We’ll continue working together to spur the more robust competition that is essential to providing all Americans with more health care choices and better quality at lower costs.
