The Healthcare Reforms Consumers Need
For over 70 years, Consumers Union has advocated for fair, rational, pro-consumer health-care policies. Our overarching goal for healthcare reform is a sustainable system that contributes to a healthy American population. This system features access to affordable, quality healthcare for every American, bold efforts to manage costs, and financing that is fair to all. This document outlines the policies that move consumers closer to this end.
If you like your health insurance coverage, you won’t have to change
For everyone else, there are new comprehensive, affordable, understandable coverage options
- New standards ensure the coverage you buy is “good” coverage – that is, coverage that provides adequate financial protection from large medical expenses and covers the services needed to maintain overall health.
- The patient’s out-of-pocket limits must be “firm” limits so there are no surprises.
- New disclosure rules make it easier to understand and compare your health coverage options.
- A new “store” called a health insurance exchange makes shopping for health coverage easier.
- A new option, the public insurance plan, competes alongside private insurance options, fostering real competition to help lower costs, driving innovation and providing a greater focus on customer service.
- Premium discounts to help lower and middle income families afford coverage.
Everyone has guaranteed access to health insurance, and everyone participates in the system
- Insurers must cover pre-existing conditions and are prohibited from imposing a waiting period before that coverage kicks in.
- “Good” coverage options and a system of premium subsidies help families comply with the coverage requirement.
- Everyone has to purchase health coverage, so that risks are spread broadly. Broadening coverage should lower premiums as they would no longer include the costs for free care received by the uninsured.
- A “hardship exemption” is in place that waives the requirement to purchase insurance if consumers find themselves without an affordable, high quality coverage option in their area, despite the new rules.
Healthcare quality improvement is a national priority
- Expand current federal programs to increase the supply of primary care providers and ensure that they are located where they are needed.
- Provide easy-to-use information on price and quality of services to help consumers compare doctors, hospitals, and treatments.
- Prohibit payment for care that arises from preventable medical errors and hospital-acquired infections, and provide information to the public about infection and error rates of providers.
- Maintain federal support for independent research that compares head-to-head treatments, drugs and medical devices so consumers and doctors can make better informed decisions—sometimes called ‘comparative effectiveness’ research or ‘health outcomes’ research.
- Institute payment reforms that pay a flat fee for managing an episode of illness to encourage better coordination of care.
A system of financing that is fair to all
- All employers but the smallest must offer or contribute to coverage.
- Everyone enrolls in coverage and contributes to the premium based on ability to pay.
- Health-care cost containment is a national priority, with specific savings targets established for all types of healthcare providers, to minimize the growing burden on taxpayers.
Do not delay
If comprehensive health-care reform is not enacted and things continue as they are, experts estimate that in the next 10 years:
- Health-care spending will rise from $2.4 trillion today to $4.7 trillion in 2019.
- Family employer-sponsored health-care premiums will exceed $30,000 a year, up from $12,680 today.
- We will spend as much as $10 trillion on unnecessary care.
- An estimated 62 million Americans will be uninsured as ever fewer people are able to afford coverage.
- More than 220,000 of these uninsured will die because they sought care too late for their medical problem.
- Over 1 million Americans will die due to preventable medical harm.
For more detailed information, see our Policy Brief “Healthcare- A Prescription for Change.”