Responding to the Coronavirus Crisis and Building a Stronger Health Sector for the Future

An open letter to the American people from 83 participants in the Health Policy Consensus Group and other health care leaders 

The COVID-19 crisis has highlighted the need for flexibility in our health sector and for public officials to do more to empower medical professionals and health care innovators to provide the care and coverage people want and need. 

Those goals must guide our continuing response to the pandemic and to making broader changes in our health sector going forward. 

The COVID-19 pandemic has exposed how government red tape gets in the way of a rapid response and interferes with patients being able to quickly and efficiently get the care they need from those they trust.

Much can be accomplished when governments enable medical innovators rather than constructing obstacles to their progress. The Trump administration, state leaders, and Congress, on a bipartisan basis, have waived hundreds of rules in a race to fight the virus.  

We should never go back.

Instead, both the administration and Congress should make these sensible temporary changes permanent and build on them with additional reforms and flexibility that will free patients and doctors, and employees and employers to make it easier to access and develop creative options.

President Donald Trump’s latest executive order takes a step in this direction by directing the federal government to continue these deregulatory efforts “with the same vigor and resourcefulness” deployed in the initial phases of the COVID-19 response.  

Changes should continue to empower private sector and state and local innovators. The federalist approach in the pandemic response has shown the strengths of our system of government in empowering states and localities with the flexibility to meet the unique challenges of communities as diverse as San Francisco and rural Montana, with the federal government playing a supportive role.   

And, when liberated from counterproductive rules and regulations, providers and suppliers inside and outside the health sector are quickly creating new and better solutions. 

Countless companies big and small have repurposed manufacturing facilities and accelerated the search for treatments and vaccines. Medical providers, patients, and plans have quickly moved to adopt telemedicine. They could do the same in producing better outcomes, lower costs, and more consumer choices to make health care and coverage more accessible.

To help Congress and the administration shape the continuing response, the Health Policy Consensus Group offers recommendations to address the immediate crisis and build a foundation for a better health sector moving forward. 

We recommend that policymakers:

Make it easier for people to access personal, “portable” health insurance” that travels with them from job to job and in and out of the labor market.  Americans need more security and control over their health spending decisions with resources they can draw on in times of a medical or economic crisis.  Through executive actions, the Trump administration has expanded opportunities for more choices of health coverage—for small businesses to join larger insurance pools to get better rates and more flexibility and to give people access to better short-term plans if they are between jobs, self-employed, working in the gig economy, retiring early, or starting a new business.  

Congress should codify these rules on short-term limited duration plans and association health plans to provide more affordable, flexible options for coverage. The president should encourage states that block access to those plans to lift the restrictions to provide their residents more affordable coverage so they can receive care from medical professionals and facilities they know and trust.  

Congress also should codify health reimbursement arrangements that allow employers to reimburse employees with tax-free dollars for individual market coverage that employees purchase outside the workplace.  And, Congress also could help overwhelmed businesses by nullifying the employer mandate for 2019-21 with its burdensome reporting requirements and threatened penalties

States should have new regulatory flexibility and budgeted resources, as described in the Health Care Choices Proposal, to respond to the unique needs of their residents. They would be able to improve insurance options for patients, including those with pre-existing conditions, target federal subsidies to vulnerable patients in most need, and empower the private sector to deliver care and services by lifting regulatory constraints that delay and even block innovation.  

Make it easier for people to communicate with their medical providers of choice – including by phone, email and video conference. The federal government should permanently codify pandemic-related regulatory relief, such as removing federal barriers to telemedicine so patients can receive care without leaving their homes. Some states have suspended the requirement that out-of-state doctors must get a new, state-specific license before they can practice in a different state. That has allowed medical providers from across the country to help patients in New York City and other epicenters of the pandemic.  Congress should follow suit, permanently allowing patients who get care funded by federal programs to see a doctor of their choice, no matter in which state they are licensed. 

Achieving this goal will also require policymakers to help patients and medical providers see each other more easily.  President Trump should use his bully pulpit to encourage states to do more to lift burdensome rules and regulations that interfere with easier access to care, including permanently lifting certificate-of-need restrictions and allowing more practice flexibility, such as letting pharmacists increase the number of tests they can perform. Congress, too, should do more, starting by repealing limits on physician-owned hospitals, which have a track record of delivering high-quality, affordable care. 

Make it easier for patients to own and control accounts to pay for their own care.  To achieve this goal, Congress should allow everyone to have a health savings account, regardless of how their health insurance is structured. It should raise health savings account contribution limits and allow the accounts to be used to pay premiums, direct primary care fees, participate in sharing ministries, and help others finance their health care needs. 

Additionally, patients should be protected from surprise medical bills by requiring transparent information and pricing, along with advance cost estimates so patients aren’t sideswiped by unexpected out-of-network charges. 

A Clear Choice: The debate today is between those who want to exert even more government control over our health sector and those, like us, who favor giving patients more choice and control and allowing the creativity we have seen in this crisis to flourish.  

We have many more specific policy recommendations than are listed here and welcome the opportunity to work with policymakers to shape the better, brighter health care future we believe can be ahead.

Signatories,

Affiliations listed for identification purposes only.