Health care reform remains a central issue for any administration aiming to enhance affordability, accessibility, and innovation in the U.S. system. An incoming Trump administration focused on market-oriented, pro-competition health reform would likely emphasize strategies to empower consumers, reduce regulatory barriers, and foster competition among providers and insurers. Below is an exploration of potential key pillars such a plan might include:
1. Expanding Consumer Choice Through Transparency
One of the cornerstones of market-based reform is ensuring that consumers have the information they need to make informed decisions. Policies could include:
- Price Transparency Requirements: Requiring hospitals and insurers to continue to disclose the actual prices of services, allowing consumers to compare costs across providers. This policy started in the first Trump administration as an Executive Order in 2019 should be enacted into law by Congress and given resources to HHS for oversight and enforcement.
- Quality Metrics Disclosure: Mandating providers to publish outcomes, patient satisfaction scores, and other quality indicators has been a long-term goal for decades with little progress. Given the federal government’s investment in health IT since 2009, it is time for a national disclosure process that protects patient privacy and increases, not decreases provider efficiency.
- Health Savings Account (HSA) Expansion: Increasing contribution limits and broadening eligible expenses to give consumers more control over how they spend health dollars. Also, Medical Savings Accounts (MSAs) for seniors should be converted to HSA policies and allowed to be harmonized between the under and over 65 populations.
2. Encouraging Competition Among Insurers
A competitive insurance market can drive down premiums and improve service quality. Reforms might focus on:
- Reinsurance Programs: Establishing federal or state reinsurance pools to stabilize premiums, particularly in the individual market. With the increase in multi-million-dollar pharmaceutical cures that may not be rare but will certainly be expensive their should be experiments to see if reinsurance can be re-designed so that one insurer is not faced with all the cost of a cure that subsequent insurers for cured beneficiary will free ride upon.
- Short-Term Plans: Expanding access to short-term, limited-duration health plans as a lower-cost alternative for those seeking minimal coverage. These plans were very helpful to lower the cost of insurance and need to be actively encouraged again, particularly when enhanced subsidies for ACA premium tax credits expire at the end of 2025.
3. Reducing Regulatory Burdens
Streamlining regulations could reduce administrative costs and encourage innovation:
- Deregulating Telehealth: Permanently loosening restrictions on telehealth services to expand access, especially in rural areas. Telehealth expanded during COVID-19 proved the scale and demand for the technology. Telehealth needs to have less regulation starting with full reciprocity of licensure to practice across state lines.
- Certificate-of-Need (CON) Reforms: Encouraging states to eliminate or reform CON laws that restrict the opening of new facilities, thus fostering competition.
- FDA Modernization: Accelerating drug and medical device approvals to bring innovative treatments to market faster.
- Abandon “March-In” Policies, Accelerate U.S.-based Innovation: To promote the development of medicines that provide cures for patients and save taxpayers billions in long-term healthcare costs, an incoming Trump administration should abandon policies chilling the nation’s innovation ecosystem. This includes President Biden’s efforts to use the federal government’s “march-in authority” to seize patent rights on inventions based on price.
4. Medicare and Medicaid Reforms
Entitlement reform is a crucial aspect of long-term sustainability:
- Medicare Advantage Expansion: Promoting Medicare Advantage plans as a competitive alternative to traditional Medicare.
- Medicaid Block Grants: Offering states the option to receive Medicaid funding through block grants or per capita caps, allowing more flexibility to design programs that meet local needs.
5. Trade and Supply Chain Reforms
Efforts to reshore business activity and reduce dependence on China are already well underway. Policymakers should be aware these efforts have economic tradeoffs. Reform efforts should:
- Recognize the Importance of Geographic Diversification for Supply Chain Resiliency: To maintain a stable, operational supply chain for medicines requires geographic diversity. Restricting manufacturing of medicines to a certain geography can raise costs, foster supply disruptions and shortages, and undermine emergency response efforts.
- Strengthen Efforts to Combat Importation of Illicit Drugs: Importation and use of counterfeit drugs is a growing problem in the United States. The Food and Drug Administration’s (FDA’s) drug distribution system is the gold standard for determining whether a medicine is safe. Foreign countries cannot guarantee the same level of safety for medicines imported into the United States. The next administration should discourage importation schemes, such as those led by state governments, that can jeopardize the safety and security of U.S. drug supply chains.
Conclusion
An incoming Trump administration focused on market-oriented health care reform would aim to harness the power of competition, innovation, and consumer choice. By reducing regulatory burdens, expanding access to diverse insurance options, and promoting transparency, such reforms could lower costs and improve outcomes while preserving individual freedom in health care decisions.
This vision emphasizes that a dynamic, consumer-driven health care market holds the potential to deliver better value and broader access to all Americans.