As a new Congress convenes, we know that the next two years will bring divided federal government – a Republican White House and Senate and Democratic House – which are unlikely to come together to make significant progress towards bringing affordable health care to all Americans. And in the waning days of 2018, a court’s decision in a lawsuit over the Affordable Care Act threw the health care world into even more turmoil, leaving many Americans uncertain of the status of their coverage.
Given this landscape, it’s easy to feel discouraged about the prospects for progress – let alone any hope for breaking through the partisan rancor that has defined the past decade of health care discussions. However, there is reason for optimism as we head into a new year, if you shift attention away from the beltway, and towards the states.
Following the 2018 midterm elections, United States of Care conducted a survey asking Americans “How important was health care to how you voted in 2018?” It’s not surprising that 82 percent of those Americans replied that health care was indeed an important part of their decision process when casting ballots. What may strike those who believe there’s a partisan divide when it comes to health care policy is that 73 percent of Republicans said the issue was important to them.
We were not surprised to see the agreement between Republicans and Democrats. Based on our outreach, focus groups, and interactions with candidates and elected officials from across the political spectrum, there are health care policy areas ripe for bipartisan cooperation—regardless of where you live, or whether Republicans or Democrats prevailed in key elections in your state.
So, while Congress and the federal government may remain in policy gridlock for the coming two years, finding these solutions in the states has real and immediate possibility for change. The question every public servant heading into state legislatures and governors’ offices across the country—ought to be asking him- or herself, is: “What actions can I take on health care immediately, in 2019?”
We’ve identified five areas in which strategic steps can be taken, right now, to build toward improving health care access and quality for millions of Americans. These are not merely quick fixes to today’s problems, but areas in which policy action can have profound effects on the overall wellness of coming generations.
The first of these is making insurance more affordable. Three traditionally “red” states — Idaho, Nebraska, and Utah — passed Medicaid expansion ballot initiatives with large bipartisan majorities, including support from the current Republican governor in Idaho.
A dozen states are exploring proposals that would allow people to purchase Medicaid coverage as an additional affordable option. States can also stabilize their insurance markets and make coverage more affordable for those who purchase it on the individual market through “reinsurance programs” that reduce premium costs. Seven states—from different regions and from historically different political perspectives—have already done so, and they received approval from the Trump Administration.
States can also address skyrocketing prescription drug prices. Outside of federal action, states can take action to address underlying prices, control state spending on drugs, and provide relief to consumers. For example, California enacted landmark drug pricing transparency legislation, which requires drug manufacturers to justify large price increases. Almost a year into its implementation, some drug companies have canceled scheduled price increases.
Protecting consumers from surprise out-of-pocket health care costs is another huge area of agreement among people from across the political spectrum. Egregious “surprise” medical bills have been highlighted in a number of recent media reports; these balance bills seek large payments from people after they have been treated in emergency rooms or are unwittingly treated by an out-of-network doctor at a health care facility that is in their insurance network. Only a handful of states currently provide comprehensive protections for patients facing this kind of scenario. Those that don’t can and should take action next year.
There is broad agreement that non-medical needs, such as access to healthy food and safe living conditions, contribute to our health. In fact, some estimates suggest that 80 percent of patient health outcomes are determined by social and environmental factors, rather than clinical care. So, state policymakers ought to look to North Carolina, where the state’s Democratic governor and Republican state legislature worked together and won the Trump Administration’s approval for a first-of-its-kind pilot program.
The program targets people experiencing challenges such as multiple chronic health conditions, substance use disorder, or a mental health diagnosis, while also facing a “risk factor” such as homelessness or domestic violence, and connects them with services including deliveries of medically tailored nutritious food or temporary housing.
Improving access to mental health care also remains a pressing need. It has been a decade since federal law requires insurers to treat illnesses of the brain equally as illnesses of the body, but still, a majority of states are failing to deliver on this promise. Policymakers can take a number of steps, right now, to improve parity and help ensure people have proper coverage for mental health and substance use disorders.
It’s heartening that we see broad bipartisan support for states tackling issues on this policy to-do list. On specific policies, nearly 9 out of 10 voters—on both sides of the aisle—told us they believe preventing surprise medical bills (90 percent of voters including 88 percent of Republicans) and preventing financial devastation from medical costs (90 percent of voters including 85 percent of Republicans) should be priorities for their state lawmakers. Both Democratic and Republican voters also told us they agree their states ought to focus on making prescription drugs more affordable (91 percent) and setting up Medicaid “buy-in” programs (89 percent of Democrats and 76 percent of Republicans).
That’s a lot of bipartisan agreement to build on at the state level over the coming two years, while in D.C. the House is likely to remain in gridlock. Let’s not squander the opportunity in front of us. And let’s keep our eyes not just on the next election cycle, but on the coming generation.