Congress Needs to Keep Working on Health Reform to Get It Right

Despite the recent House of Representatives vote on the American Health Care Act, there remains a great deal of uncertainty over what will happen in the Senate. As the CEO of a large nonprofit health system, I have one message to lawmakers and our president: Keep working. There are a number of less controversial but no less consequential reforms they can make that can dramatically alter the health care landscape in a positive way.

First, they must continue to provide funds that reduce the out-of-pocket deductibles and copays for lower income enrollees in the exchanges. Like most hospitals, we provide care regardless of the patient’s insurance status or ability to pay, and as a result we write off hundreds of millions of dollars in uncompensated care each year. The cost-sharing subsidies included in Affordable Care Act have helped decrease uncompensated care. They are an important part of the ACA and provide critical assistance to lower-income enrollees by reducing their out-of-pocket deductibles and copays. Without cost-sharing reductions, the deductibles and out-of-pocket costs will rise quickly, insurers will pull out of the market, and individuals will stop getting the care they need because it will become unaffordable. We strongly support continuing both premium tax credits and cost-sharing reductions.

Second, we need commonsense regulatory reform. The world has changed dramatically since laws governing health care were originally adopted. They simply need to be updated to encourage coordination of patient care while still maintaining a competitive marketplace.

Third, we need to address the rising cost of pharmaceuticals that are part of the cost pressure facing our health systems. We spent $270 million on prescription medicines last year, an 18-percent increase over the previous year. This is not sustainable. Drugs are a major expense for health systems and an uncontrolled cost to our patients when they go to the pharmacy. This may be one area where bipartisan consensus can be reached on how to rein in the skyrocketing costs of prescription medicines.

Next, President Trump has spoken about the need to invest billions in our infrastructure investment — we urge our elected leaders to invest more in the public health infrastructure, and finally acknowledge and address the growing health care disparities in our country, whether by geographies or demographics. Every American deserves equal access to healthy food and environments that support exercise.

Finally, we need to ensure that the millions of Americans who gained coverage through the ACA maintain that coverage; allowing the exchanges to collapse would harm the millions of American who count on coverage to get the medical care they need.

If the Congress and the administration will make these changes, Novant Health and other hospital systems like us will continue to improve our ability to deliver high-quality care and reduce costs, which have been substantial. We consistently score highly on several of the common quality measures used by Medicare, and we lowered the cost of care with our employees last year for the first time ever. We self-insure our employees, and last year our spending went down by more than $1 million while, most importantly, the overall health of employees improved.

Our success in driving better health at a lower cost is extraordinarily satisfying, but further progress is in jeopardy if our elected officials cannot reach a consensus on the relatively straightforward policy reforms I’ve outlined above. If they will act, we will be able to continue to provide the high-quality, more affordable care that our patients demand and deserve.


Carl Armato is CEO of Novant Health, an integrated nonprofit system of hospitals, physician practices and outpatient centers operating in North Carolina, South Carolina, Georgia and Virginia.

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