Panelists Discuss Insurance Coverage, Health Reform, and the Well-Being of the Country

Once a decade, the United States makes an effort to make healthcare more equitable and fair, and to improve the healthcare system and pass major legislation, explained Andy Slavitt, chairman of United States of Care, at PULSE: The Atlantic Summit on Health Care. However, when trying to fix or reform the US healthcare system, there are a number of questions that need to be addressed about the type of care and access that people should have.

Slavitt highlighted the fact that the people in the room likely have a different healthcare experience than other Americans. “We do have a great healthcare system for a lot of us,” he said, but there are people in rural America or who have basic needs that aren’t being met, and when a health issue happens they might not be able to afford it, recognize the situation, or know what to do.

“Generally speaking, these are people with ordinary healthcare conditions, the same ones we [in the room] have, but extraordinary circumstances in their lives which makes getting healthcare harder,” he said.

In order to fix this issue, the country needs to decide if it wants to fix the healthcare system or if it wants to focus on keeping people healthy throughout their lives, Slavitt said. One aspect of the US health system that needs to be fixed, he said, is the investment in primary care. He highlighted primary care, mental health care, and social services as areas where the “rest of the world invests 2 times as much” as the United States does, and “as a result they have to spend half as much as we do” on their healthcare systems.

“We habitually underinvest,” Slavitt said. He recommended creating more jobs for people who focus on taking responsibility for patients early on and paying them more. Another suggestion was to combine the social services and healthcare budgets, so these health issues can be looked at holistically.

“I would begin actually focusing on the cultural issues that are endemic here,” he added. The opioid crisis is actually a diseases of despair crisis, Slavitt said. There is a huge addiction problem in the country and addressing the supply issue isn’t enough.

Slavitt, who is the former acting administrator of CMS, also took time to discuss the Affordable Care Act (ACA), which he called “a partial success.” The law’s biggest accomplishment was that it allowed people to feel safe in knowing they would have access to health insurance if they lost a job or decided to become self-employed.

However, success for the ACA is not just about the law, it’s about the implementation of the law. And for the last few years, both political parties have been working hard to pull the law in opposite directions.

“We need to find a way to change that, and I think it’s almost surpassed healthcare costs as our biggest challenge—that is, the broken politics,” Slavitt said. “It is far too profitable for both Democrats and Republicans to be divided than it is to unite around common goals.”

Slavitt was then joined on stage by Ceci Connolly, president and CEO of Alliance of Community Health Plans, and Matt Eyles, senior executive vice president and chief operating officer of America’s Health Insurance Plans (AHIP), for a panel discussion on healthcare coverage in the United States.

Connolly started the conversation by explaining that “healthcare has become a bit of a slog in the United States,” and that healthcare leaders need resilience. “It feels like we’re repeating ourselves with many of the same challenges that keep coming around,” and leaders need to “be able to take a few knocks and get back up again.”

She explained that the same challenges keep coming back around because healthcare, in general, is complicated, but also that there is a lot of money in the system, as well as perverse financial incentives.

Eyles added that health plans are concerned about 2019 and that AHIP had been lobbying for a reinsurance package in the omnibus spending bill, because it is expected that a reinsurance program would help push down premiums. That reinsurance program wasn’t included in the bill, which was one of those “knocks” Connolly mentioned that they had to bounce back from.

The result is continued uncertainty. Part of the reason, Slavitt explained, is that it can’t be fun for the Trump administration, or any administration, to implement a law like the ACA that it doesn’t believe in and that it wouldn’t have passed. However, many insurers in the individual market are seeing profits now, he added.

“[Insurers] want a signal from the administration that says, ‘we’re not going to mess with this thing,’” Slavitt said. “I think that’s the reasonable thing to expect, and I think you’d see expansion, and I think you’d see rates start to come down.”

That effort at implementation and putting insurers at ease will likely lead to a much healthier individual insurance market, Slavitt believes.

Connolly added that premiums are just a reflection of healthcare costs, such as hospital costs, physician visits, specialists, and prescription drugs. So, bringing down premiums would also require bringing those costs down.

“So, as much as you get frustrated with your co-pay, or your premium, or your deductible, as a nation, we’ve got to be willing to look at the underlying cost of care,” she said. “And we also have to look at the health and well-being of our nation.”