Going Backwards Is Not an Option: Progress for Health Care Must Cover More, Not Fewer

After years of steady progress, we are now at risk of losing ground in building the American health care system we deserve. Reports emerging from the Senate indicate that the discussion is focused on how fast to roll back expansion of coverage rather than how to take the next steps forward and build on the progress we’ve made to date. So far, little debate seems to be focused on policies that help our nation continue to transition from a “sick care” system to a better organized focus on prevention and helping people live healthier lives.

We need to pause and ask policymakers to answer the most fundamental question: What does progress on health care look like for the people in America? Three simple, yet important, measures exist – and any change will be judged by history by its impact on access, affordability and outcomes.

First, we need to cover more people, not fewer people. Any proposed approach to health care reform must cover more people than the number who have access to high-quality health care today. Over the last few years, 20 million uninsured people gained access to health care coverage, and the number of uninsured people dropped to record lows. Yet about 28 million people remain without health care coverage. While this represents progress, today we still have an unacceptable number of people without access to health care coverage.

Reasonable people can debate how we progress to a zero number of uninsured people, how generous the most basic coverage needs to be, and how we pay for it. Let’s be clear: This isn’t a partisan goal. Both parties have ideas on how we can expand health coverage effectively using a blend of public and private solutions. Providing targeted subsidies for people to purchase insurance on the exchanges and expanding Medicaid have, for the most part, been efficient and effective. Targeting subsidies in a better way is certainly possible and we should explore that. Any bill that increases the number of uninsured – and the Congressional Budget Office estimated the House bill would leave 23 million more Americans without insurance – is unacceptable.  

Second, without question, we must make health care more affordable. If we are going to cover more people, we – our government, businesses and families – are going to have to foot the bill. Rising deductibles and premiums reflect the increasing costs of care delivery – not just adjusting rules around health coverage. Immediately and over the long term, we should be focused on bending the health care cost curve. It’s possible to achieve more efficient and effective care delivery if we work together. Any proposal moving forward should accelerate work to achieve high-quality, affordable and accessible health care.

Third, we must do everything in our power to make sure a country as great as ours boasts the best health outcomes – the quality of care – in the world. We still have a way to go when measured against many countries outside of the United States. The health care industry can achieve greater outcomes and affordability if we commit to moving from a predominantly “sick care,” episodic, fee-for-service model to a predominantly preventive model with incentives for value, integrated care and, most important, keeping people healthy. Providing more people with health care coverage and granting access through the front door of the health care system will make preventive care possible. And that means early detection and treatment become a more affordable model, which makes maximizing healthy life years possible for even more people in America.

What do these three simple tests reveal about our current debate? We need to take this conversation to the next level, past partisan politics.

The Affordable Care Act is imperfect. Unfortunately, since its passage in 2010, we have made practically no change to the original bill, making further progress impossible. At the same time, the proposed replacement, the AHCA, would have millions of people move back to being uninsured. This is not forward progress. 

The evidence shows that under the AHCA, we will have 51 million uninsured individuals in America within the next decade, and those who can least afford the cost will pay more. The Senate should not aim to simply make the number of people losing insurance smaller than it would be with the AHCA.

Racing to reform health care without offering a workable alternative with broad national support is not the way to go. We need our elected representatives to work together to make progress, not to go backwards. We know that people do not want to return to a health insurance market in which sick people are charged more or denied coverage altogether. People want comprehensive health coverage. They want lower premiums and lower cost sharing, while gaining access to high-quality affordable care in a system that is focused on their health – and ready to care for them when they are sick.

We can achieve better health for all if we deliver on the three-part test for access, affordability and outcomes. It will take time, and our country must reflect that we, as individuals and communities, must do better.