President Trump has used his executive authority to make positive reforms that are bringing affordable health insurance to consumers and small businesses. However, for many people, access remains a challenge. More than half of all Americans routinely delay getting proper care because of worries about costs.
Through additional executive actions, President Trump can resolve to make three crucial health care changes in 2020 — changes that will lower costs and improve efficiency. Should the president fulfill them, these New Year’s resolutions would bring excellent benefits to the American people.
First, the president should resolve to instruct the Department of Health and Human Services (HHS) to implement reciprocity for prescription medicines that have previously received approval by countries deemed to have acceptable standards for safety and effectiveness. This would give patients faster access to new beneficial drugs, increase competition, and lower pharmaceutical costs while ensuring drug safety.
Second, President Trump should resolve to direct HHS to update the Centers for Medicare and Medicaid Services (CMS) risk adjustment formula to remove inequities that favor larger insurers over smaller ones.
The Patient Protection and Affordable Care Act (ACA) included a risk adjustment program that transfers funds from health plans with relatively healthier enrollees to those with sicker enrollees. Although the program only involves private insurers, CMS administers it.
The ACA eliminates the ability of insurers in the individual and small group markets to shield themselves against risk by varying premiums or coverage in response to factors like health status, gender, and to some extent, age. Risk adjustment is intended to reduce insurers’ incentives to avoid enrolling those who are likely to experience high health care costs, ensuring premium differences between plans are based on design and available benefits rather than enrollee health risks.
But CMS’ risk adjustment formula has been criticized for understating risks for healthier enrollees and overstating risks for those with significant medical conditions, thereby overcharging plans for healthy enrollees and overpaying them for sicker ones.
According to the Initiative for Health Care Affordability, enrolling a young, healthy person can sometimes force insurers to pay risk adjustment transfers that exceed enrollees’ premiums. CMS’ methods exaggerate this payment disparity in other ways. The payment anomaly disadvantages small insurers relative to larger ones.
Also, the risk adjustment program is administered at the state level. Because some small insurers operate solely within single states, unfavorable state regulatory policies can force them to close their doors. Given that ObamaCare will likely not be overturned in 2020 — the need for complex and challenging to administer cross-subsidies like this is among the key reasons to jettison the law — the administration can act to remedy this inequity among smaller and larger insurers.
Third, the president should resolve to finalize the administration’s “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs” and issue simplified rules that reduce the administrative and regulatory burdens associated with the use of information technology and electronic medical records.
Burdensome regulations and administrative requirements cause doctors to waste way too much of their valuable time typing instead of spending it with patients. According to a recent study, many doctors spend nearly half their time dealing with electronic health records and administrative tasks vs. only 27 percent on direct clinical care.
The Trump administration deserves great credit for reducing physician documentation for individual office visits this year as part of its “Patients over Paperwork Initiative.” But there is much more that can be done to eliminate bureaucratic red tape.
As CMS Administrator Seema Verma aptly stated in 2018, “Over the past year, we hosted listening sessions, received written feedback, and heard from a wide range of clinical stakeholders about the current health IT systems and the requirements specifying documentation, reimbursement and quality reporting that are burdensome and should be re-examined.”
By carrying out the preceding New Year’s resolutions, President Trump lower health care costs and give Americans better access to affordable health care in 2020.
Roger D. Klein, J.D., M.D., is a member of the Regulatory Transparency Project on health care. He is a former adviser to the FDA and HHS. He graduated from Yale Law School and completed his post-graduate medical training at Yale Medical School.