At The Table With Solutions To Stop The Rising Cost Of Care

posted by AHIP

on December 18, 2018

180 million Americans. More than half the U.S. population. 90% of the American workforce. No matter how you count it, it’s a lot of people. And all of them count on health care coverage provided through their employers.

While more than 80% of American workers say they like the benefits they receive, there’s still work to be done to ensure affordable, accessible coverage is available to all Americans. And not only is AHIP at the table—we’re at the table with solutions, like a report recommending 12 policies that federal and state leaders should implement in the individual market to drive down premiums, increase participation in the marketplace, and lower costs for consumers.

Many of these recommendations would also make an important difference in the lives of small business owners and their employees. Here are three key ways policymakers can help lower the cost of care for small businesses, hardworking Americans, and their families:

1. Reduce surprise doctor bills

Too often these days, when patients and their families go to the hospital, they’re worried not just about getting better—but also about if they’ll get a surprise doctor bill in the mail. It shouldn’t be that way.

Insurers work with hospitals and doctors to set rates for the cost of care, and cover much of the cost of care when a patient receives in-network care. However, you could go to a hospital in your network, but be treated by an out-of-network doctor—without being told about it. And what’s more, because out-of-network doctors don’t have a set contract with insurers, they can charge whatever they want—giving them an incentive to stay out-of-network and not work with insurers on behalf of patients.

That’s just wrong—and policymakers can do something about it by:

  • Regulating how much out-of-network doctors can charge patients and their insurers
  • Ensuring patients at an in-network hospital are told if a doctor is out-of-network—before they’re treated

2. Delay the Health Insurance Tax

The Health Insurance Tax is a policy that’s meant to make health insurance more affordable by taxing health insurance … because the first thing you do when you want to make something more affordable is place a sales tax on it.

It doesn’t make sense to us, either—and it will have a real economic impact on millions of Americans, including employers who provide health care coverage and their employees who rely on it. The tax was delayed for 2019, but it’s scheduled to take effect in 2020, at a cost of $16 billion. That’s $16 billion on the backs of hardworking Americans, families, seniors, and the most vulnerable among us. By suspending the tax, Congress could save small businesses thousands of dollars in health care costs and workers hundreds of dollars on their premiums each year.

3. Address out-of-control drug prices

Prescription drug costs eat up the highest percentage of every dollar an employee pays towards their health insurance premium—even more than inpatient hospital care. Pharmaceutical companies continue to price-gouge patients with excessive price hikes year over year—and sometimes even multiple times a year.

But there’s good news: there are many ways to help slow out-of-control drug prices. If, that is, Congress and the Administration take action. Those include:

  • Enforcing and strengthening direct-to-consumer advertising rules, so patients know the real cost of a drug
  • Increasing competition in the marketplace by finalizing rules about biosimilars and reducing red tape for generic alternatives to costly brand-name drugs
  • Requiring transparency in pharmaceutical prices, including more information on the true cost of research and development and reasons for price hikes
  • Promoting value-based pricing, so patients aren’t paying more for a drug that’s doing less

These are just three proposals of many that can help reduce the rising cost of care for small business owners, hardworking Americans, and their families. The insurance providers who partner with employers to deliver affordable, accessible care are committed to making the system work better for everyone. Solutions are on the table—it’s up to Congress and the Administration to serve them up.