HHS Secretary: U.S. needs to move from illness-based to wellness-based health care system

Illustration of a variety of people with illnesses.

By Susan Rupe

WASHINGTON - The U.S. has a nationwide system of health care, but not a national system for public health. The difference between the two means that every state determines how health care should be delivered.

“We are more of an illness care system. We need to move toward a wellness care system,” said U.S. Health and Human Services Secretary Xavier Becerra, who delivered the opening address at America’s Health Insurance Plans’ 2023 Medicare, Medicaid, Duals and Commercial Markets Forum on Tuesday.

“Every state determines how they want to do it. But if a state decides they don’t want to do it, then they won’t do it,” he said. “The result is we have different outcomes in each state.”

"People come in to the health care system when it’s very late in their situation.”U.S. Health and Human Services Secretary Xavier Becerra

In addition, Becerra said, the U.S. health care system is one in which “people come in to the health care system when it’s very late in their situation.”

Becerra called for moving the U.S. health care system from an illness care system to a wellness care system “and even out the bumps and valleys that sometimes fail to serve the entire nation.”

“A national system for public health would ensure we have the data we need to send the resources where they need to go,” he said. “A national system would have made sure the COVID-19 vaccine was evenly distributed.”

Becerra described AHIP and its members as “those leaders who came to the table, whether it was dealing with COVID-19 or behavioral health.”

“I hope we recognize if we do that partnership right, we’ll do it affordably and we’ll do it equitably. If we do that, even if we have a patchwork of health care determined by each state and their authorities, we can still bring it together and make it nationwide system.”

A record number of Americans – an estimated 300 million - have health insurance coverage – whether it is through employer-based coverage, government programs such as Medicare and Medicaid, or through individual plans purchased through the Affordable Care Act marketplaces. Becerra said that despite the high number of insured, several factors must be addressed in order to maintain and strengthen these coverage gains. They include:

Preventing Medicaid beneficiaries from losing coverage. Millions of those who enrolled in Medicaid coverage during the COVID-19 pandemic are on the brink of losing that coverage, after the omnibus spending bill enacted by Congress in December changed the enrollment rules. This means that the individual states must requalify Medicaid recipients over the next year, and as many as 18 million Medicaid recipients could lose coverage.
“The reality is that, of the folks who are on the verge of losing Medicaid, we know many of them will qualify for ACA coverage,” Becerra said. “We are trying to work with every governor to make sure there is a smooth transition to ACA coverage if possible. Many Medicaid recipients have an opportunity to get insurance through their employer because they are working, or they can qualify for the CHIP program for their kids, or for other state-specific programs.”

One challenge surrounding the Medicaid unwinding, Becerra said, is that many states have not upgraded their systems for tracking Medicaid enrollees. “We fear many people will lose coverage because there isn’t a way for them to update their information with their states,” he said.

Making ACA subsidies permanent. Becerra said President Joe Biden is pushing for a permanent ACA tax credit for those who receive insurance under the exchange but would hit the subsidy cliff without the tax credit. Those tax credits were expanded under COVID-19-related legislation.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.