CHHS’s Department of Health Administration and Policy and the Center for Health Policy Research and Ethics wrapped up the annual Health Policy Institute in June. Designed for professionals in the health care field, George Mason graduate students, policy analysts, and government office staff, the summer short course was timely given health care reform efforts underway. It offered participants the opportunity to better understand the issues affecting recent health care legislation as well as the problems state and federal officials are working to address.
The course featured 19 speakers at the forefront of health policy, including individuals representing various constituent and party views. The institute featured presentations on Capitol Hill agendas as well as bipartisan efforts to engage the new administration. Panels on community innovations to address population health and approaches to expanding access and coverage to health services and health insurance coverage were also included. Speakers covered a variety of viewpoints on topics including pharmaceutical costs and development, personalized medication, Medicaid and Medicare, Medicaid expansion, stabilizing the Affordable Care Act (ACA) Marketplaces, Capitol Hill agendas under the current administration, employer concerns, health informatics, influencing health policy, and the details of the current American Health Care Act (AHCA) and related legislation. On the final day of the class, the American Nurses Association arranged a visit to Capitol Hill and meetings with selected participants and their representatives.
Speakers covered a wide array of information and observations, but here are 10 key takeaways:
- Personalized medicine is the future of health care, with the promise of tremendous health care cost savings.
- The AHCA is limited in what it can change. It is a reconciliation bill that must follow special rules and therefore can only address tax and federal budget issues. It cannot address some highly contested aspects such as the individual mandate (although it can change the penalties for not following mandates).
- Under the AHCA, covering 10 essential health benefits will be left up to the states. Each state will decide if they will mandate coverage of health benefits such as maternity care and prescription drugs.
- The AHCA allows insurers to calculate risk differently and reduces low income subsidies. This can make coverage much more expensive for those that are older, have lower incomes, or have pre-existing conditions. However, it could make coverage cheaper for those that are young, healthy, and have higher incomes.
- It is difficult to estimate the full impact on recent Medicaid expansions; but early results show beneficial results. There is strong evidence that state expansion has had positive impacts on coverage, access, affordability, and hospital and state finances. However, some state policy changes were made concurrently and the decision to expand may have been correlated with other factors.
- We’re moving from a volume-based to a value-based provider payment system. Alternative payment methods may create a “zero-sum game,” by setting up providers in competition with each other and giving incentives or penalties for patient outcomes.
- Incentives for drug innovation may have to be weighed against lower costs for buyers. Drug development is expensive, and 88% of drugs fail – never making it “from bench to bedside.” However, the pharmaceutical industry has traditionally been one of the most profitable. A balance will need to be struck between user affordability and incentives to develop new drugs (such as the length of patents).
- The cost of health insurance is a top concern for small business owners. This is especially important for small businesses with less than 50 employees given their limited operating budgets.
- To influence policy, you must find your allies. You must know who can influence change and you may have more of an impact if you team up with individuals or organizations with similar interests. Health care professionals could have great influence over health care reform, particularly at the state level.
- U.S. health policy is very complex and not easy to figure out without considerable effort. A course like this can guide learners through many of the intricacies.
Dr. PJ Maddox, chair of CHHS’s Department of Health Administration and Policy and one of the faculty members teaching the course explains, “We provide participants with the tools to analyze research from a variety of sources, identify opportunities for change, understand how leadership roles can influence policy, and learn how to engage with stakeholders to meet their goals. We hope that they really understand how powerful they are as advocates in the health care field.”