BCRA and AHCA – Both are fixes, neither are solutions

Written by Ryan Marling, Research Associate, The Clayton Christensen Institute for Disruptive Innovation |

An opinion-editorial by: Ryan Marling, Research Associate, The Clayton Christensen Institute for Disruptive Innovation

As Senate Republicans continue to debate the health care bill, Americans should know they still have cause for concern. Of the two partisan-structured bills set before them, neither fully address deficiencies in how health care is delivered, nor the reason it is expensive in the first place. It is doubtful that additional tweaks will accomplish this in any meaningful way. Instead, the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA) essentially shift the financial burden of the world’s most expensive health care system to the individuals and families least likely to afford it.

Let’s Face It: Americans Are Sick and Ready for Change

In comparison to virtually every other developed nation, the U.S. pays significantly more for a health care system that performs among the worst when you consider rates of chronic conditions, obesity, and infant mortality. Americans are also the most likely to encounter access-to-care issues related to cost. These colossal shortcomings explain why many Americans were ready for change when the 2016 election came along.

Repealing the Affordable Care Act (ACA), a core campaign vow of President Trump and many of the GOP elected to Congress, resonated with voters looking for better care at a lower cost. But nobody won voters for their compelling plan to replace the ACA, which involves making difficult trade-offs on high-stakes issues likely to alienate potential voters. As is often the case, the void left by the absence of a plan was filled instead with lofty promises. Now that the public has gotten a look at the Senate version of the ACA “repeal and replace” bill, it has become clear that many of the GOP’s campaign promises regarding health care are not achievable by way of payment reform alone.

Campaign Promises, Battered and Broken

Most Americans can get behind lower health care spending, but things get dicey when it comes at the expense of coverage. With that in mind, the Congressional Budget Office’s (CBO) estimate of the latest bill projects that more than 22 million additional people could go without insurance over the next decade, either by choice or disqualification. Even if the revised draft can reduce that number by half, which is highly unlikely, leaving 11 million people in the lurch is not a viable solution. While the government may spend less in this scenario, each iteration of proposed legislation fails to provide a way to reduce the actual cost of care-leading to coverage losses and leaving American families and individuals to foot the overwhelming remainder of the bill.

Rather than addressing the underlying causes of unsustainable health care spending, the next GOP alteration of their ACA replacement bill will likely continue to shift more of the unwieldy cost of our system to those most likely to need care. The current version does this by watering down the actuarial values of the most affordable exchange plans while granting states waivers to back out of Essential Health Benefits (EHB) requirements and out-of-pocket spending limits. With “coverage” more likely to result in access to $6,000 deductibles and unaffordable care, fewer healthier individuals would make the investment in a health plan on the exchange, risking adverse selection and even higher costs for those who need to purchase a health plan. This, along with significant cuts to Medicaid, which has an underlying structure based on preventative and cost-effective care, add up to more broken promises and Americans getting less value than they deserve from the country’s health care system.

The Time Is Ripe for Innovation

Redesigning our nation’s health care system is no small task, but we are destined to fail if we ask the wrong questions from the start. Rather than asking, “How can we afford our current health care system?” lawmakers should ask, “How can we change the system to make health care more affordable?”

Our health care system is bloated with inefficiencies and waste, due in major part to complexity and poor integration between providers and payers. Americans desperately need solutions that address the outdated processes and broken business models that perpetuate these high costs and poor patient experiences across the country. To address the actual cost of care, the bill would need to encourage new and innovative models that impact what care is delivered, by whom, where, and when. Possible solutions could address improving coordination of care for patients with chronic diseases, helping physicians practice at the top of their license, and reaching patients with preventative care before they would otherwise end up in the emergency room.

By reframing the problem and orienting the solution towards making health care affordable from the start, we would not only reduce waste, but improve value. It is fitting that lawmakers are delaying the vote until after Independence Day-during which we celebrate a successful political revolution. A revolution is needed, indeed, and it can be won if reformers turn their attention to the less glamorous task of innovating the business models through which we actually deliver care as opposed to remaining fixated on the large-scale and endlessly controversial issue of who pays for it.
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