The Heartland Institute, which co-publishes Health Care News, published an updated version of its American Health Care Plan (AHCP) in September that identifies steps states can take now to improve health care costs, access, and quality instead of waiting for Washington, DC to act.
The 2024 edition, “American Health Care Plan: State Solutions,” includes nine actions states can take to mitigate the federal government’s intrusive role in health care, which intensified under the Biden administration. The reforms are already underway in some states.
Health care freedom and competition have been under greater attack as the Biden administration has tried to increase the dominance of Obamacare by using taxpayer-funded subsidies to increase enrollment and making things difficult for states such as Texas, which resisted pressure to expand their Medicaid programs.
The current administration also reduced the duration and renewability of short-term insurance and changed the payment structure in Medicare Advantage to make it less attractive to insurers and ultimately enrollees.
‘States Can Act More Quickly’
The ACHP’s nine state reforms include stepping up efforts to eliminate Medicaid waste, fraud, and abuse, using “reference-based pricing” to increase price transparency, eliminating certificate of need laws to increase competition, and ditching prior authorization mandates to streamline the delivery of health care.
Other recommendations include easing restrictions on direct primary care, expanding telehealth, expanding “right to try” legislation, forming compacts with other states to ease health care provider shortages, and encouraging states to be more active in applying for state waivers to be free of federal regulations.
“States have always been laboratories of democracy,” said Matt Dean, one of the authors of AHCP: State Solutions and a Heartland Institute senior fellow for health care policy outreach. “States can act more quickly, and legislators know the needs of the residents better than any federal bureaucrat. In essence, we can get 50 different solutions for any one problem, and we can see what works.”
‘Commonsense Solutions’
States are well-placed to implement the suggested reforms, says Lee S. Gross, M.D., chairman of DPC Action and founder of Epiphany Health Direct Primary Care.
“The national landscape of federal health care policy is mired in obstructionism and political brinksmanship, leaving little room for meaningful reform,” said Gross.
“In contrast, states, which must address their citizens’ needs, have greater opportunities for innovation and compromise,” said Gross. “The AHCP framework offered by The Heartland Institute offers commonsense solutions with the potential for immediate, meaningful impact.”
Targeting for Better Service
Attention to eliminating waste, fraud, and abuse in Medicaid and ramping up applications for federal waivers are two recommendations Gary D. Alexander, the director of the Medicaid and Health Safety Net Reform Initiative at the Paragon Health Institute, says grabbed his attention.
“I’m surprised a lot of states haven’t taken advantage of these options,” said Alexander. “States must have a focus on making Medicaid or any welfare program fiscally sound so they can better serve the people they are intended to help. In fact, they should have dedicated units. And maybe the feds should incentivize it by increasing the administrative reimbursement if the state saves money.”
Alexander says past initiatives in Pennsylvania (a welfare-system-wide Program Integrity Initiative) and Rhode Island are excellent examples of how such a focus can pay off.
“Rhode Island had a surplus in Medicaid in 2013 after it asked for and received a waiver in 2010 to cap Medicaid expenditures,” said Alexander. “And it happened with a Republican governor and a heavily Democratic legislature, so it can be done. What is the excuse in Florida, or Georgia or any other states?”
States will have to resist industry pressure, says Alexander. “The managed care lobby is very powerful,” said Alexander.
Biden-Harris Regulation Push
In 2021, Heartland released the AHCP as the new Biden administration began undoing Trump administration reforms and taking advantage of COVID-19 pandemic fears to increase government power over health care. The administration pushed mask and vaccine mandates and censored COVID-19 “disinformation.”
The AHCP proposed a list of federal reforms that would “lower health care costs, increase access to high-quality care, and introduce market forces in a health care system that has become overly bureaucratic and too focused on a one-size-fits-all approach.”
A primary feature of the AHCP has been a lifetime “health ownership account (HOA).” The Health Care Fairness for All Act introduced by Rep. Pete Session (R-TX) in 2023 has come closest to expanding personal accounts. Congress has yet to move on such reforms.
AnneMarie Schieber (amschieber@heartland.org) is the managing editor of Health Care News.
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