AHIP releases legislative, regulatory policy guide aimed at addressing care access and cost 

America's Health Insurance Plans launched Healthier People through Healthier Markets on May 17, a new policy guide with proposed solutions aimed at improving healthcare affordability and access. 

The effort is focused on boosting competition in healthcare markets and reining in harmful practices. The launch included letters to President Joe Biden and congressional leadership to detail legislative and regulatory enforcement actions AHIP believes will increase competition in healthcare, drive down costs and improve access for members.

Payers have committed to working with federal and state officials and other healthcare leaders to accomplish the goals within the guide. 

Ten proposed solutions:

  1. Support consumer-centric expansion of home-based advanced care through value-based care and payment models.

  2. Bring transparency to private equity firms' monopoly power in air ambulance, emergency and certain specialty services that often provide services on a fee-for-service basis.

  3. Advance site-neutral payments so that consumers don't pay more for the same services depending on the site of care.

  4. Support patients' choice of telehealth when clinically appropriate as a less costly and more convenient method of care. Accomplish this by removing government impediments, modernizing network adequacy regulations and guarding against regulatory structures that reduce telehealth's competitive benefits.

  5. Address harm caused by the dialysis duopoly by preventing its further expansion, removing barriers to care alternatives that are better for patients and reducing the use of charitable structures that redirect resources to fortify the duopoly.

  6. Stop consolidated health systems from using their monopoly position to stifle negotiation and innovation through the use of all-or-nothing, anti-tiering, and other take-it-or-leave-it contract terms.

  7. Accelerate the availability of prescription drug biosimilars to ensure the pace of access matches the pace of innovation. 

  8. Stop drug manufacturers from engaging in patent games that distort the system to maintain monopoly profits.

  9. Reform the system for provider-acquired drugs, which has resulted in ever-escalating prices for such drugs.

  10. Address the ways in which drug manufacturers have abused charitable structures to protect their monopolies rather than help patients.

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