Matthew Kandrach – President, CASE

July 12, 2018 – https://washex.am/2ufXYBS

With summer upon us and the midterm elections looming large, Congress should take this time to take important steps toward reforming our healthcare system, increase competition, bring down prices and improve quality of care for patients this year. The Trump administration has paved the way by streamlining regulations to help spur competition and increase transparency – but, there’s still more work to be done.

At the top of the list is fixing Medicare Part D. Back in February, during negotiations around the Bipartisan Budget Act, lawmakers dramatically reduced the program’s competitive structure and eliminated incentives for insurers to keep costs low. Most significantly, Congress altered what’s known as the “donut hole,” or a gap in coverage in which patients must pay a large portion of the cost of their care out-of-pocket.

Although the donut hole was set to be phased out in the next decade, Congress sped up the clock, reducing the competitive balance of the program. Insurers were previously responsible for a portion of the costs in “the donut hole,” but Congress let them off the hook. Now insurers are not responsible for any of the payments, while manufacturers and the government split the remaining costs. While previously insurers were incentivized to keep patients out of the donut hole to keep their costs low, they now have no such incentive. Even the Centers for Medicare and Medicaid Services raised concerns about the change.

Part D is often cited as the most successful government program as it cost $555.8 billion less in its first 10 years than originally projected. This is due to Part D’s competitive structure, in which private insurers compete with one another for business, ensuring greater choice and more affordable plans.

That’s why it’s surprising that Congress did anything to change this program.

But now they can undo their mistake, restore the competitive structure to Part D and help ensure the program remains cost effective. Congress can also act to fix the antiquated 340B program. Instituted in the early 1990’s, 340B is intended to provide medications to community health centers at a discount, with the intention that those institutions use the reduced financial burden to provide comprehensive care for vulnerable populations and patients.

But like so many government programs, the path to government waste is paved with good intentions. Too many hospitals have not improved care for vulnerable populations, but have instead reduced charity care. In fact, the New England Journal of Medicine found that the program “provides no direct incentives” for hospitals to help low-income patients. Similarly, the Government Accountability Office found that participating hospitals are incentivized “to prescribe more drugs or more expensive drugs to Medicare beneficiaries.”

Congress should use this time to inject accountability into the program to ensure that hospitals cannot continue to profit from a system intended to benefit the most vulnerable Americans.

Finally, Congress must act to repeal the Affordable Care Act. Though the Trump administration has done what it can to maximize options for patients and reduce regulations that are trapping Americans in expensive health plans, Congress must take up this fight.

Already, insurers are predicting double-digit premium increases in 2019, meaning that patients with few options will be forced to pay more for their care. The American people elected this Congress to carry out their agenda, including repealing Obamacare. It’s time that our representatives made good on that promise.nd choice for the American people. Though reforming each of these issues may seem daunting, we need our leaders in Washington to act on this “wish list.” Nothing less than will do.