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Can We Save American Healthcare?

The Health Equity Collaborative has released a new white paper that outlines where healthcare is going wrong – and how we can fix it.

Sometimes it’s like the elephant in the room – but all US citizens are uneasily aware that our healthcare system is suffering. Maybe even failing altogether. That’s why the Health Equity Collaborative (HEC) is so passionate about educating healthcare professionals, politicians and policy makers, and the public about what’s happening – and how we can fix it.

The nonprofit organization’s new white paper, “Putting Profits Over Patients: How the Corporatization of American Healthcare is Impacting Diverse Communities“, presents a comprehensive and nuanced approach to policy reform. It addresses systemic issues within the U.S. healthcare system and identifies critical areas where reforms can significantly impact, particularly benefiting diverse communities that have historically been marginalized or underserved by the current healthcare infrastructure. 

The paper’s focus areas include establishing Pharmacy Benefit Manager (PBM) transparency and fairness, scrutinizing industry consolidation, fixing the broken 340B program, requiring fair, site-neutral payments, and ensuring patients are protected from unexpected medical bills. 

Solutions Tailored for Diverse Communities

HEC’s white paper begins by emphasizing the need for solutions specifically designed to address the disparities faced by diverse communities. It argues that the corporatization of healthcare has led to a system where decision-making power is increasingly centralized and detached from the needs of patients, especially those from diverse backgrounds. The paper calls for a holistic approach that integrates social determinants of health to create a more equitable healthcare system.

Establishing PBM Transparency and Fairness

The white paper highlights the opaque nature of PBM operations as a significant barrier to cost-effective healthcare. PBMs, which serve as intermediaries between insurance providers and pharmacies, often employ rebate schemes that inflate out-of-pocket costs for consumers. HEC advocates for reforms that would require PBMs to disclose actual drug costs, ensure competitive, value-based fees, and prevent practices like “steering,” where patients are forced to use PBM-owned pharmacies. These measures seek to dismantle the shadow industry of PBM manipulation, promoting transparency and fairness that would directly benefit patients.

Scrutinizing Industry Consolidation

HEC’s analysis of industry consolidation addresses the trend of hospital and health system mergers, which have frequently led to higher costs and reduced care quality. The white paper suggests that more stringent reviews of merger proposals are necessary, alongside enhanced information sharing between the Federal Trade Commission (FTC) and state/local authorities to effectively challenge anti-competitive mergers. It also proposes legislative measures to ensure that even small healthcare transactions undergo scrutiny, in order to prevent the monopolization of healthcare services.

Fixing the Broken 340B Program

The 340B Drug Pricing Program, designed to allow hospitals treating underserved communities to purchase drugs at discounted prices, has been subject to abuse. HEC’s paper outlines reforms requiring participating entities to report how savings from the program are utilized to benefit communities. It also calls for measures to prevent hospitals from exploiting the program for profit, ensuring that savings are reinvested into community healthcare services, thereby enhancing care quality and availability for underserved populations.

Requiring Fair, Site-Neutral Payments

The white paper addresses the issue of site-neutral payments, focusing on the practice of charging different rates for the same services based on the location. This practice has led to increased costs within the Medicare system and added financial strain on patients. HEC supports proposals that would eliminate exemptions allowing hospital outpatient departments to charge higher rates and reduce Medicare reimbursements for services that could be performed in a doctor’s office. Such reforms would alleviate cost pressures on the Medicare system and impact private insurance, benefiting patients across the board.

Ensuring Patients Are Protected from Unexpected Medical Bills

Finally, HEC’s white paper tackles the critical issue of “surprise medical bills,” exacerbated by the complex and often non-transparent billing practices of insurance companies. Despite the No Surprises Act’s intentions, enforcement and compliance issues persist, leaving patients vulnerable to unexpected and unjust financial burdens. The paper advocates for stronger enforcement mechanisms, transparency in billing practices, and ensuring insurers fulfill arbitration-determined payments to protect patients from financial exploitation.

Addressing the Urgent Need for Reform

HEC’s new white paper presents a thoughtfully constructed framework for policy reform. There’s an urgent need to dismantle the systemic barriers that contribute to inequities within the U.S. healthcare system. HEC has addressed key areas – PBM transparency, industry consolidation, the 340B program, site-neutral payments, and surprise medical billing. And it’s not afraid to be a raised voice in the ongoing dialogue to reform healthcare. Yes, healthcare policies are complex – but we need to collaborate in order to achieve equity and justice for all communities.

The Health Equity Collaborative (HEC) is a diverse community comprised of dozens of national, public health, patient advocacy, and multicultural organizations that are committed to supporting equity and combating disparities experienced by underserved populations. HEC is officially a project of MANA Action, a 501c4 not-for-profit organization.

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February 13, 2024

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