AHIP’s Policy Roadmap Aimed At Increasing Health Care Access, Affordability

Washington, D.C. – May 17, 2022 – Today, AHIP launched Healthier People through Healthier Markets, a new policy roadmap and set of solutions to improve health care affordability and access for every American. The effort is focused on boosting competition in health care markets and reining in harmful practices that hurt American families. With the launch of this policy roadmap, AHIP sent letters to President Biden and the leadership of Congress that lay out a detailed set of legislative and regulatory enforcement actions to increase competition in health care, drive down costs, and improve health care access for patients.

AHIP’s solutions are designed to improve competition in 10 key areas of our health care system to increase affordability and access for every American. They are based on four straightforward commitments to patients, consumers, and businesses, including:

• Improving patient choice.
• Protecting patients, consumers, and businesses from overpaying for care.
• Improving transparency.
• Stopping drug pricing and patent games by Big Pharma.

“When robust competition exists in our health care system, negotiations between private sector entities work to encourage innovation, quality improvements and more affordability. But increasingly limited competition in certain health care markets is often leading to unsustainable price increases and fewer choices for patients and consumers,” said Matt Eyles, AHIP President and CEO. “The status quo is unaffordable for American families and businesses, and that is why we’re putting forward meaningful solutions that will promote greater competition and access while improving affordability. President Biden and leaders in Congress have made fighting consolidation a priority across industries, and our Healthier People through Healthier Markets roadmap offers specific, concrete actions that can and should be taken at both the federal and state levels to reduce prices and costs by improving competition through smart health policy and increase affordability and access.”

View the AHIP letters and the full Healthier People through Healthier Markets agenda.

The 10 key areas where federal and state policymakers can take action to improve health care competition and promote greater access and affordability are aimed at achieving those core commitments. They include:

1. Support consumer-centric expansion of home-based advanced care through value-based care and payment models – an alternative that can offer patients better, more convenient, and more affordable care outside of the hospital.
2. Bring much-needed 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 to defend consumers against having to 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, by removing government impediments, modernizing network adequacy regulations, and guarding against regulatory structures that reduce telehealth’s competitive benefits.
5. Address the harms caused by the dialysis duopoly by preventing its further expansion, removing barriers to care alternatives that are better for patients, and curbing 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 that 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.

As part of today’s announcement, health insurance providers committed to working with federal and state officials and other health care leaders to accomplish these goals. By prioritizing these reforms and taking concrete actions, AHIP believes that patients will have more choices, employer coverage will be more affordable with better benefits, and treatment programs will be more accessible and affordable for patients.