As a divided Congress prepares to take up health care reform once again, a national organization that advocates for employer sponsored health plans has shared a lengthy and detailed wish list for elected officials to consider.
The American Benefits Council is urging lawmakers to build on gains made during the pandemic that favor employer benefits plans, and then to use those gains as a platform to further support the millions of Americans who receive health benefits at work.
“Pursuing health care policy reform in a divided Congress is a challenge, but with every challenge comes opportunity,” American Benefits Council Senior Vice President, Health Policy, Ilyse Schuman said. “One clear direction Congress can follow is to strengthen the employer-provided health coverage system that is favored by Americans across the political spectrum and support employers’ efforts to address some of the nation’s most significant health care challenges.”
In a letter to Congress replete with supporting evidence, Schuman outlined four key areas where legislative action could greatly enhance the ability of employers to offer health benefits that both improve the lives of plan members and offer better care at a lower–or at least a more consistent–cost to the sponsor.
- Preserve and strengthen employer-provided health coverage
- Lower cost and improve value
- Leverage telehealth to improve access and value.
- Combat the mental health crisis.
Leaving nothing to chance, Schuman and the council included detailed instructions for Congressional members to consider when addressing the four priorities. Their list of reforms was supported with the inclusion of an exhaustive list of studies supporting their requests.
A major cause for concern: the ongoing and rapidly increasing consolidation within the provider industry. The council examined the effects of consolidation from every vantage point: how current regulations actually incentivize independent practices and hospitals to merge with larger entities; the reality that mergers have led to higher rather than lower costs to employers; how those same mergers foil employer attempts to select higher quality providers; and why the myth that benign cross market mergers do not raise prices or undercut quality fails the test of reality.
“In concentrated markets, prices do not flow from competitive negotiations, but from the outsized leverage that market concentration affords. Large hospital systems attempt to leverage their significant market share by forcing plans to contract with all affiliated facilities and prevent educating patients about lower-cost, higher-quality care. These anti-competitive contract terms in the form of “all-or-nothing,” “anti-steering,” “anti tiering” and “most-favored-nation” contract provisions foster inflated costs and limit plan sponsor’s flexibility in plan design to promote access to high-value care,” the council wrote.
“The Council urges Congress to address the anti-competitive contract terms that disrupt market dynamics and raise the cost of health care services across the system. Legislation, such as the bipartisan Healthy Competition for Better Care Act from the last Congress would, in the aggregate, increase competition and promote lower costs by restricting such contract terms. Congress should enact such legislation.”
Other major areas of reform requested by the council: price transparency, both for hospital treatment pricing and prescription drug pricing; removal of barriers to accessing mental health services; better ways to manage and pay for plan members with chronic disease conditions; cost-shifting to employers rather than true cost/price reform; greater access to telehealth services.
Noting that the relatively small percentage of plan members with chronic conditions drives the overall cost to all members (and sponsors), the council urged Congress to act to address this imbalance.
“It is critical that individuals with chronic conditions have access to the care and medications they need, including allowing plans and employers to offer more chronic disease preventive-care benefits pre-deductible in health savings account (HSA)-eligible high deductible health plans (HDHPs). Accordingly, we urge Congress to pass legislation:
- such as the Chronic Disease Management Act from the 117th Congress that would allow HSA-eligible HDHPs to provide access to health care services and medications that manage chronic conditions on a pre-deductible basis.
- to make permanent the ability of HSA-eligible HDHPs to cover, on a pre deductible basis, telehealth, which has been a vital lifeline for millions of patients, including for primary care and behavioral health services. o to allow HSA-eligible HDHPs to cover primary care services pre-deductible.
- to allow more robust services, including primary care services and management of chronic conditions, at on-site clinics pre-deductible to provide greater flexibility for HSA-eligible HDHPs to promote value-driven care.
“Such legislation would give employers the ability, if it suits their workforces and plan design, to make chronic disease prevention and management more affordable and accessible.”
The council noted that the legislative initiative to improve price transparency has been moving forward. But, it said, much work needs to be done.
“Congress can and should take bold steps to address the root causes of rising costs and improve transparency for payers in the system. Any proposal that merely shifts costs to employers should be soundly rejected,” the council said.
The letter addressed the gains realized through telehealth during the pandemic and requested that more steps be taken to expand telehealth’s efficacy. “Barriers remain to realize the full potential of telehealth to improve access to affordable, high-quality care, especially mental health care.
The mental health crisis exploded during the pandemic, and its fallout continues to disrupt the workforce. “Employer efforts to combat the nation’s mental and behavioral health crisis must be supported by policies that strengthen the mental health provider workforce; leverage telehealth; increase integration, coordination and access to care; and promote the use of evidence-based behavioral health care.”