Today’s health care reality

Ask most consumers and they will tell you that rising healthcare costs have been a financial anchor for too many for far too long.  When families are struggling every day just to keep up, we must do better.  

And for the 11 million consumers who rely on the insurance exchanges for their coverage, we need to act now to create a sound, stable future. 

{mosads}However, the level of premium increases we’re seeing in the exchanges have not – and are not forecast to – hit other consumers.

But we need to do more to bring down health care costs for everyone – and we can when the private market is allowed to work.  In a healthy market, consumers have a stable range of affordable choices and patients get better care more efficiently. 

For the more than 150 million Americans who get their insurance through their employer, last year’s premiums rose by 3 percent, according to a new report by the Kaiser Family Foundation and the Health Research and Educational Trust of the AHA.  The Congressional Budget Office expects that rate to hold through 2018.  And 80 percent of consumers are satisfied with their employer benefits.  

We’ve seen similar results in Medicare.  Premiums in Medicare Part D continue to be stable.  Nearly one third of all beneficiaries – more than 17 million – are now enrolled in private Medicare Advantage plans because they deliver affordable choices, effective benefits, and comprehensive coverage – including additional services like vision and dental care that are not covered by traditional Medicare.  That’s why nearly 90 percent of beneficiaries are satisfied with their Medicare Advantage or Part D plan. 

In the states, Medicaid managed care now enrolls more than 70 percent of all Medicaid beneficiaries.   And when Medicaid plans manage both medical and pharmacy benefits, states are seeing significant savings.

The Centers for Medicare & Medicaid Services recently announced a half a billion dollars in cost savings from an important program known as the Medicare Shared Savings Program.  Hospitals and physician groups are driving down costs by improving the quality of care. 

These types of value-based solutions focus on delivering the most efficient and effective care to improve individual health. 

Using modern technology, tools, and treatments to deliver the right care at the right time.  Better ways for doctors, nurses, pharmacies, health plans, and others to work together across the continuum of care.   Using the most effective approaches to treat – and prevent – disease.  These approaches have delivered results. 

Key indicators like hospital readmissions have gone down while patient safety has gone up.

By focusing on better quality and more choices, we can actually bring down costs.

That’s a particular challenge when it comes to the rising cost of prescription drugs.  

We’ve all seen the egregious price increases for life-saving medicines.  The nearly 600% increase in the cost of an EpiPen, a common treatment that families rely on to save lives from allergic reactions, is just the latest example. 

Unjustified and unaccountable spikes in prescription drug prices are the engine of higher costs.  Despite historic lows in overall cost growth for years, drug spending grew by more than 12 percent in 2014 – and is expected to outpace overall growth for the foreseeable future. 

From open, honest information for consumers about the real costs of prescription drugs, to genuine solutions that increase market competition; reward products that deliver value; reform the regulatory process; encourage more innovation – we can expand access to life-saving treatments while also bringing down their costs. 

We do not have to choose between affordability and access.  We can make real changes that deliver both.

Lowering health care costs is a commitment everyone can – and must – embrace.  So that small businesses can grow . . . so that families can get ahead, not just get by . . . so that seniors have the peace of mind they deserve.

A healthy private market – with real choice, informed consumers, and effective care and treatments – can deliver better quality and affordable coverage for everyone.  And if we work together – doctors, nurses, hospitals, health plans, and other partners – we can build that future.

Marilyn Tavenner is President and CEO of America’s Health Insurance Plans, the national trade association representing the health insurance industry. Rick Pollack is President and CEO of the American Hospital Association, the national trade association representing hospitals and health systems.

The views expressed by authors are their own and not the views of The Hill.


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