A Conservative Approach to Better Health Care
Experience and Results Like No Other
Obamacare is the Wrong Diagnosis and Must Be Repealed and Replaced: Access to affordable health insurance is an important priority but Obamacare has failed to achieve this because it has driven up the cost of health insurance approximately 80 percent in Ohio’s individual and small group market and raised taxes to help subsidize health insurance coverage for families making up to $94,000 annually. Too often Obamacare mistakes treating symptoms for solving problems which only worsens the overall, long-term problem. John Kasich believes Obamacare must be repealed and replaced with efforts that instead improve access by actually lowering health care costs without interfering with Americans’ personal health care decisions or imposing punishing burdens on job creators.
The Real Problems Remain Unchanged: Americans get what we pay for in health care, and too often what we pay for is more care instead of better care. In many areas a predominantly fee-for-service system creates financial incentives for health care providers to perform more services for a person who is sick rather than work to keep that person healthy. As a result, an estimated one-third of America’s health care dollars are wasted on things patients don’t need (IOM 2009) and, at the same time, 55 percent of Americans have been found to go without recommended treatments for preventive care and chronic care management (NEJM 2003). The time has come for leadership to fix it.
A New, Conservative Vision: In Ohio, health care purchasers, health insurance plans, and providers realize the current system is unsustainable and are working–together with Gov. Kasich’s Administration–to explore new payment models that, instead of just rewarding volume, reward value that helps people stay healthier.
• Better primary care (patient-centered primary care): The first step is having a primary care system that helps promote long term good health instead of just reacting when someone gets sick. Ohio is working through its Medicaid system to encourage patient-centered primary care practices that go the extra distance to keep people healthy and thereby help control costs. Savings generated this way accrues, in part, to health insurance plans as avoided costs. To help incentivize more robust participation in this model,Ohio’s four largest commercial insurers—Anthem, Aetna, Medical Mutual and UnitedHealthcare—as well as Ohio’s five Medicaid managed care plans, are designing a system that also shares those savings with the providers whose work helps improve health and hold down costs.
• Rewarding value instead of volume (episode-based payments): Even with primary care payment reform, high-cost episodes will continue to account for most health spending. Today we pay for all of the inputs in these episodes separately, but if these inputs were considered as a whole then the providers involved would, similarly, work as a team to control costs and maximize quality. In a joint replacement, for example, surgeons, anesthesiologists, hospitals, device manufacturers, rehabilitation therapists, and drug makers all have separate roles and little incentive to worry about each other’s costs. Instead, what if the surgeon earned more for meeting high quality standards while also better managing the entire procedure in order to produce lower costs? Many providers are actually doing this today but the savings only accrue to the health insurance plan, not the high-value provider who generates it. In March, 2015, Ohio began working with our state’s four largest commercial insurers—Anthem, Aetna, Medical Mutual and UnitedHealthcare—and five Medicaid managed care plans, to set this model in motion for certain high-cost episodes.
The Path Forward: Everyone knows that Obamacare must be repealed and replaced with something that actually works in line with America’s market-based principles to help Americans be healthy. So, let’s not only oppose Obamacare but also put in motion real solutions that will work to improve health care access by holding down costs and help Americans live healthier lives. The Ohio model provides a path forward for the nation: patient-centered care, choices, market competition, decentralized decision-making, higher quality, respect for individuals and an end to Obamacare’s big government interference.
Following the principles that have long served America well means returning control of health care choices to patients and returning full control of insurance market regulation to states. In doing so we will help more Americans get and stay healthy in a high-quality and affordable way that sustainably supports our country’s long-term economic growth.