Originally published in the Pittsburgh Tribune-Review.
We didn’t need a global pandemic to remind us that our health care system is broken and unaffordable. Countless Pennsylvanians have avoided a doctor visit for fear of unexpected bills. Many have gone months, or even years, without the ability to afford an insurance plan. And some have turned down a job because it couldn’t provide family medical benefits.
The culprit: corrupt federal regulations that only benefit special interests. This tangled web of rules separates doctors from patients. For decades, it has impeded U.S. health care while causing prices to skyrocket. As America endures the covid-19 pandemic, it’s important to remember recent reforms and ongoing efforts to fix our health care system.
Before the pandemic, the Trump administration had advanced reforms — short-term health plans, price transparency, and association health plans — that began to improve Americans’ access to health care. Today, the vast expansion of telehealth, along with the lowering of prescription drug prices for Medicare patients, is redefining access to care.
This encouraging shift began in 2018, when short-term health plans — basic medical plans typically used to bridge the gap for those between jobs — were significantly expanded. During the Obama administration, consumers were prohibited from buying short-term plans that lasted longer than three months. Then, two years ago, the Department of Health and Human Services (HHS) reversed this rule by allowing individuals to keep their short-term plans for up to 364 days; they can also renew annually for up to three years.
Expanding short-term plans increased marketplace competition and gave Americans access to more affordable plan options. In Pennsylvania, the average monthly premium for a short-term plan for a 40-year-old, non-smoking woman is now half of what it would cost on the individual market — $288 compared to $575 using 2018 figures. In addition, there are nearly 20 times more short-term plans than individual market plans. Empowering Pennsylvanians with the freedom to choose this low-cost, temporary option is a key step to restore affordable access to care.
Price secrecy was another impediment to affordable care. Hospitals notoriously keep patients in the dark about prices, which leads to costly bills or skipped appointments. The evidence is clear: when consumers can easily compare prices, the cost of care goes down. In New Hampshire, for example, consumers saved 36% on imaging services by shopping.
To protect patients, HHS announced two rules in 2019 requiring hospitals and insurers to disclose prices before patients receive care. U.S. senators have since introduced the Health Care PRICE Transparency Act to codify these transparency rules.
Then, the Labor Department finalized a rule easing barriers to association health plans — a way for small businesses to band together and provide their employees with health coverage. In Pennsylvania, fewer small businesses have offered health insurance due to soaring costs. Making health insurance more affordable via association health plans has helped small businesses maintain workers amid state-level covid-19 restrictions.
And today, a proposed alternative to Obamacare would focus on lowering costs by empowering patients. Known as the Health Care Choices 2020 proposal, it could reduce premiums up to 24% by eliminating government restrictions on what insurance plans cover. It would also provide specialized plans to those with preexisting conditions, and give low-income Americans the ability to use Medicaid or CHIP insurance dollars on a different plan of their choice.
Finally, while HHS relaxed telehealth restrictions for Medicaid and Medicare patients, overall telehealth use is still limited by uncertainty. Providers need assurance that they will be reimbursed. Unfortunately, in Pennsylvania, this has become a partisan issue: a bill to expand telehealth was vetoed by Gov. Tom Wolf in April.
But other efforts are underway, including a bill sponsored by Rep. Jesse Topper, R-Bedford, that passed the state House earlier this month. The legislation would allow nurse practitioners to treat patients without bureaucratic burdens, lowering health costs and expanding access — particularly for those in counties like Allegheny and Westmoreland with at least one health professional shortage area.
Fixing America’s health care system will take time but the signs of progress are encouraging. If our elected leaders in Washington and Harrisburg can continue to peel back rigid restrictions, we can make health care more accessible and affordable for everyone.