Between the party-line Democratic votes to pass the Affordable Care Act in 2010 and the very likely party-line Republican votes to repeal critical parts of it in early 2017, a bipartisan group of state health policy leaders (Reforming States Group) recently released a letter to the incoming Administration that proposes a modest federal-state policy agenda designed to advance the Triple Aim.
Three members of the group summarized their proposals in a Perspective article in the New England Journal of Medicine that began with language that was music to my public health-trained ears:
State leaders understand that as a society we are spending our health care dollars in the wrong ways for the wrong things—emphasizing treatment over prevention and medical care over social services. …High-cost, high-need patients swamp Medicaid programs; prisons have become de facto treatment systems for substance use disorders; today’s neglected children are tomorrow’s state responsibilities; low- and middle-income families struggle with rising health care payments; and the demands of an aging population increasingly tax families, health care systems, and communities.
The four key components of their agenda are as follows:
- Support state efforts for broad reforms of health care payment and delivery.
- Support state efforts to address causes and improve management of chronic illness.
- Support state use of data to inform policy.
- Strengthen the state-federal partnership on health to assure the greatest impact from federal investments.
Limited as it is, this bipartisan policy consensus has a chance to gain traction as a “long-term agenda for governing” because it intentionally “avoids focusing on any single health care issue currently grabbing headlines.” Improving population health is, after all, a long-term proposition that requires vision rarely seen in national politics these days. For example, buried in the acclaim, heaped upon the recently enacted 21st Century Cures Act, was that well over half of it was paid for by gutting the Prevention and Public Health Fund, which had already sustained substantial cuts in previous years to offset more visible or politically advantageous budget priorities.
In an era of increasing federal government paralysis, perhaps state leaders can find a way forward on priorities for health reform. Before Obamacare, there was Romneycare. There are still too many people in this country who can’t access essential social services or medical care (even if they have health insurance). Too many people who have health insurance but delay dental care they can’t afford and suffer permanently debilitating consequences. If President-Elect Trump wants to “make America great again,” he can start by recognizing that we are far too great a nation to continue to allow these things to happen.