A Real-World Health Care Solution

As a nurse for more than 40 years, I saw how health care decisions in Washington impacted real people and I learned that one of the biggest challenges of health reform is finding ways to keep costs low while improving outcomes and helping Americans lead healthier lives.

I also learned that, in order to get there, we should not have to ask more of American taxpayers. This year alone, the government will spend about $1 trillion on healthcare programs. So instead of simply throwing more money at the problem, we need to spend our dollars more effectively to improve the value of care delivered.

One way we can control spending is by addressing manageable problems before they become big problems. Studies have shown that regularly taking doctor prescribed medication is an important step in preventing health issues from escalating into serious, life-altering conditions that can place a tremendous financial burden on the healthcare system, on patients and their families. With such a simple solution, why aren’t more folks taking their medication?

As anyone with a chronic health condition will tell you, sticking to a constant regimen of medication isn’t cheap. A diabetic, for example, could end up spending $250 a month on test trips and $200 a month or more on insulin. When families are forced to choose between buying groceries and getting a prescription filled, their health is sidelined and the long-term costs to our healthcare system can increase as a result. By the same token, evidence has shown that reducing co-payments for high-value prescription drugs results in increased use, better health, and cost savings.

One of the most promising approaches to addressing the cost of medication without overstepping the government’s bounds in the marketplace is Value-Based Insurance Design (V-BID). Instead of the current one-size-fits-all approach to cost-sharing or copayments, V-BID embraces the idea that, by lowering a patients’ out-of-pocket costs for essential prescription drugs and services, consumers will then be motivated to stick to their regimen and stay healthier – in turn decreasing the overall long term costs to our healthcare system.

Based on these facts, I introduced H.R. 2570, the Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act. My bipartisan legislation establishes a regional demonstration program for high-quality Medicare Advantage (MA) plans that allows the use of V-BID to reduce the copayments for beneficiaries with specific chronic conditions. This bill would enable individuals with chronic diseases to stick to a sustainable treatment regimen and avoid more costly care in the future.

H.R. 2570 also drives down healthcare costs by eliminating unnecessary  burdens on physicians and providers.  Today, many outpatient surgery centers are penalized for not adopting a new, government-mandated system of electronic record keeping. While these systems may make sense in a hospital setting, they don’t always work for a small outpatient surgery center. It is a catch-22 situation that forces physicians who work in these settings to either perform even minor, outpatient procedures in a hospital, which means higher costs for the patient, or face enormous government penalties. My legislation gets Washington off the backs of our healthcare providers by eliminating this burden for doctors.

As Congress continues working to repeal Obamacare and roll back other burdens this Administration has placed on patients and their doctors, H.R. 2570 is a meaningful, real-world solution that offers a chance to improve health outcomes and reduce barriers to quality, affordable healthcare for those who need it most.

— Representative Diane Black (R-TN)

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