At EOI, we are now six weeks into our health policy work through the Pacific Hospital Preservation and Development Authority grant to develop policies for the preservation and expansion of health coverage at the county and state levels.
But we are not doing it alone. We are taking a community-based approach, inviting participation from local stakeholders and marginalized communities who have the most to gain or lose from changes in healthcare policy. Developing policy without meaningful involvement from these communities would run the risk of misdiagnosing the issue at best, or perpetuating oppression at worst.
To help guide our work, I devised a preliminary set of principles based on conversations with community members that will be used to screen policy options for improving health coverage. This list will likely evolve over the next few weeks as we conduct listening sessions with community organizations and continue one-on-one conversations and technical work group meetings with health policy experts, provider groups, state-level health agencies, and others.
New health-care strategies should:
Premiums, deductibles, and out-of-pocket expenses should be affordable relative to household income. The Affordable Care Act did not go far enough when it deemed a plan “affordable” that costs 8% or less of an individual’s income in premiums – that doesn’t account for the fact that out-of-pocket expenses can add up, still making health care prohibitive for low- and middle-income people. Truly affordable coverage may require increased subsidies through progressive tax reform or other equitable financing.
Build on Existing Infrastructure When Possible
Existing health care systems that provide affordable, quality care should remain intact or be expanded to save resources, capitalize on institutional expertise, and avoid trauma associated with assimilating into a new system. The Department of Veterans Affairs, Medicare, Medicaid, the Health Benefits Exchange, and the Public Employee Benefits Board are examples of systems that can be improved upon or expanded to provide culturally competent care within a structure that participants are comfortable with.
Sustainable health reform calls for addressing what creates high-cost health care: administration, prescription drug prices, unnecessary services, and a fragmented financing and health-care delivery system. Strategies to combat rising costs include global budgets for hospitals instead of reimbursing claims on an individual basis, consolidated systems to handle claims, and increasing purchasing power to negotiate lower drug prices.
Health insurance should provide access to medically necessary services that most people need; this includes mental health, vision, dental, specialty care, long term care, and primary care services.
Be Under Public Control
Our health care system can better reflect the needs and preferences of communities by allowing for greater transparency and opportunities for and public governance over fiscal or operational components such as covered services, reimbursement rates, and costs to consumers. For example, the Washington Legislature’s House Bill 1026 would have created a board of technical, citizen, and administrative subcommittees to have governing authority over a health security trust to provide increased access to care.
Provide for Everyone
Health coverage should be universal – provided for all residents regardless of citizenship status, duration of lawful permanent residency, or county of residence.
Over the next few months, we will publish more detailed analyses of health care issues and our work as we progress.
This post was written by EOI Policy Intern Christina Leal.