By Sabrina Corlette, Karen Davenport, and Stacey Pogue
Americans rank health care costs ahead of housing, utilities, and groceries as their main source of financial stress. To help policymakers confront these affordability challenges, the Georgetown University Center on Health Insurance Reforms (CHIR) has released A 3-Part Strategy for Better Health Insurance: Reducing Costs, Complexity, and Corporate Abuses, a new brief by CHIR experts Sabrina Corlette, Karen Davenport, and Stacey Pogue that details actionable federal solutions.
Per-enrollee spending for commercial health insurance is growing faster than inflation and many families have been forced to drop their coverage in the wake of the recent expiration of enhanced Marketplace tax credits. These trends are resulting in deep anxiety and economic hardship for the 161 million Americans who rely on commercial health insurance.
CHIR’s new brief offers federal policymakers a three-part blueprint to reform commercial coverage:
- Reduce costs: Cap annual deductibles at $1,000 for individuals, lower out-of-pocket maximums, limit excessive hospital prices, expand no-cost access to primary and behavioral care and generic drugs, and extend Medicare drug price negotiations to commercial plans.
- Reduce complexity and red tape: Implement common sense reforms of prior authorization, establish a market-wide essential health benefit floor, eliminate the employer coverage “firewall”, end coinsurance, and help patients navigate complex coverage and billing questions.
- Protect patients from corporate abuses: Close loopholes in the No Surprises Act and replace the high-cost Independent Dispute Resolution system with non-inflationary payment benchmarks, rein in profit-seeking middlemen and private equity extractive practices, and create a Hospital Fair Billing Certification to prevent medical debt.
By targeting the core drivers of health system dysfunction, policymakers can lower costs, eliminate administrative hassles, and restore patient-centered care.
CHIR is composed of a team of nationally recognized experts on private health insurance and health reform. The report is supported by the Robert Wood Johnson Foundation and available on the CHIR website.
