{"id":592341,"date":"2026-04-08T00:37:10","date_gmt":"2026-04-08T00:37:10","guid":{"rendered":"https:\/\/www.newsbeep.com\/au\/592341\/"},"modified":"2026-04-08T00:37:10","modified_gmt":"2026-04-08T00:37:10","slug":"top-dem-think-tank-unveils-next-big-health-care-push","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/au\/592341\/","title":{"rendered":"Top Dem Think Tank Unveils Next Big Health Care Push"},"content":{"rendered":"

\"\"<\/a>(Shutterstock)<\/p>\n

HIGH-PROFILE DEMOCRATS HAVE BEEN saying their health care agenda can\u2019t simply be about undoing all the damage that Donald Trump has done to Medicaid and the Affordable Care Act\u2014that they need to focus on the underlying forces driving up costs<\/a>, which ultimately make health care more expensive for everybody.<\/p>\n

A prominent think tank with close ties to the Democratic establishment is about to unveil a proposal designed to do just that.<\/p>\n

On Wednesday morning, the Center for American Progress<\/a> will introduce a set of proposals<\/a> to limit what hospitals and insurance companies can charge, while also limiting the ability of insurers to deny coverage that doctors recommend to their patients.<\/p>\n

The proposals, which CAP senior staff shared exclusively with The Bulwark, aren\u2019t fully fleshed out in the way, say, a bill in Congress would be. It\u2019s a starting point for future legislation\u2014a set of ideas that political leaders could debate and refine, tout on the campaign trail and, eventually, attempt to pass into law.<\/p>\n

CAP is widely known as the unofficial policy incubator for moderate-to-liberal Democrats, which means its proposals are likely to get a serious hearing in Washington. Veterans of past Democratic administrations are heavily represented in the group\u2019s upper ranks. Many would probably end up back in the executive branch\u2014or with jobs on Capitol Hill\u2014if Democrats get control of either or both in upcoming elections.<\/p>\n

And insofar as CAP\u2019s agenda is indicative of where the party establishment\u2019s brain is right now\u2014or, at least, where CAP current leaders would like it to be\u2014this new proposal signals a few important shifts in thinking about health care.<\/p>\n

For one thing, the focus of this new agenda is very clearly on improving affordability for everybody, rather than getting coverage for those who are uninsured. \u201cIf you want to address people\u2019s concerns about health care, their concerns are driven by high health care costs,\u201d CAP president Neera Tanden<\/a> told me in an interview. \u201cIt\u2019s important to put forward ideas that will help the 91, 92 percent of Americans who have insurance.\u201d<\/p>\n

Tanden said the decision to focus on costs didn\u2019t mean CAP was backing off its commitment to universal coverage<\/a>. \u201cWe believe health care is a basic human right,\u201d she told me. Nor did Tanden suggest deemphasizing the importance of reversing GOP cuts<\/a> to Medicaid and the Affordable Care Act, which together are projected to leave tens of millions of Americans either with more expensive coverage or altogether uninsured.<\/p>\n

But, Tanden and her colleagues said, it was important to address the cost issues as soon as possible. They also said it was important to address sources of everyday frustration for those who are already insured, especially when it comes to denials of treatment that, in the worst of cases, can make it difficult for people to get the care they need.<\/p>\n

\u201cIt doesn\u2019t mean we shouldn\u2019t talk about expanding coverage\u2014that\u2019s always going to be a part of the agenda,\u201d Topher Spiro<\/a>, a CAP senior fellow who oversees health policy, told me. \u201cIt\u2019s just a recognition that we\u2019re at a breaking point on costs . . . and we need to take that on.\u201d<\/p>\n

The CAP plan seeks to accomplish that by having the federal government get a lot more aggressive about using its regulatory power to hold down costs. Mainly it targets hospitals, by attempting to set a ceiling on what they can charge, and insurers, by putting new limits on their ability to raise premiums. There\u2019s also a set of provisions that would change the way insurers review recommended treatments for approval, in some cases removing altogether their right to block specific treatments.<\/p>\n

CAP is billing the proposal as a \u201cpatients\u2019 bill of rights,\u201d on the theory that it would protect patients from both unfairly high costs and unfair scrutiny of their medical care. And like any such proposal, it\u2019s sure to draw objections from serious people who think it would do too much or too little, or simply wouldn\u2019t work well.<\/p>\n

But whatever its virtues or flaws\u2014both worthy subjects of future debate\u2014the proposal represents an important departure from the status quo. To see how and why, it helps to understand a sharp turn in policy that took place about fifty years ago.<\/p>\n

PICK ANY PEER COUNTRY you want\u2014Germany<\/a>, France<\/a>, Japan<\/a>, the Netherlands<\/a>\u2014and you\u2019ll discover they spend far less<\/a> on health care than we do, in both the collective sense (i.e., measured as a percentage of their total economic output) and the individual sense (i.e., measured as each individual\u2019s financial obligation).<\/p>\n

The reason is that their national health systems do more than simply guarantee coverage for everybody. They use government leverage<\/a> to limit or set prices for what hospitals, drug makers, and every other provider of health care can charge patients.<\/p>\n

The United States has at times attempted to regulate prices in similar ways, even without a national health plan in place. And that has included efforts\u2014mostly at the state level\u2014to restrict what hospitals could charge. But by the late 1980s and into the 1990s, nearly every state had taken its hospital price regulations off the books<\/a>.<\/p>\n

One reason was that the whole concept of government meddling with prices on health care\u2014or any good for that matter\u2014had fallen out of political fashion. It was the height of the Reagan era<\/a>, although this thinking was by no means limited to Republicans and conservatives. Plenty of Democrats and liberals agreed, following the cues of trusted advisers who believed that competition among providers of health care, as well as among insurers, was the best way to drive down prices while promoting more efficient, higher-quality medical care.<\/p>\n

You can see that thinking in the way American health care works today\u2014including through the Affordable Care Act, which attempts to tap market forces by, for example, having insurers compete for customers on HealthCare.gov<\/a>. But while there\u2019s a respectable case<\/a> that the law as a whole really did restrain health spending, relative to what it might have been, in recent years costs have once again started to increase more quickly.<\/p>\n

A likely culprit in this is an increase in costs from hospitals, which are the single biggest component<\/a> of overall health spending. And there\u2019s lots of evidence that consolidation is driving that increase, because larger, newly merged hospitals have a lot more power to demand high fees\u2014in some cases, acting like monopolies.<\/p>\n

That realization has prompted many analysts\u2014even card-carrying economists who a decade or two ago would have been content to let the free market do its thing\u2014to suggest it\u2019s time for the federal government to intervene more directly.<\/p>\n

\u201cMarkets in the U.S. have become broken,\u201d Zack Cooper<\/a>, a Yale economist who has published groundbreaking research<\/a> on the effects of hospital mergers on pricing, told me. \u201cI don\u2019t think it\u2019s a lack of faith in the virtues of competition. I think it\u2019s a question of whether a large share of markets can generate competitively set prices. And there\u2019s evidence to suggest they can\u2019t.\u201d<\/p>\n

The CAP proposal takes that thinking and runs with it, by calling on the federal government to prohibit hospitals in \u201cconcentrated markets\u201d from charging fees that are more than three times what Medicare currently pays. Nonprofit hospitals with higher charges could lose their tax-exempt status under the CAP proposal, while for-profit hospitals could face some kind of financial penalties. A separate set of proposals would seek to limit what some insurers could charge, while strengthening existing restrictions designed to limit how much of their money goes to profits and overhead.<\/p>\n

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The proposal leaves out lots of important details\u2014including, for example, exactly how officials would determine what qualifies as a \u201cconcentrated\u201d hospital market where the government\u2019s rules would kick in. It doesn\u2019t take a ton of imagination to guess the kind of scrutiny it\u2019d draw from the left, where critics would probably say the proposal is too complex and tries to dodge the broader restructuring necessary for real relief. It is similarly easy to imagine attacks from the right, where critics would say regulations are bound to push prices either too high or too low, forcing excessive spending or shortages or some combination of the two.<\/p>\n

But whatever the merits of those arguments, it says something that the analysts whom CAP consulted on the plan include some of the best known figures in the field. Several told me they thought the package was a sensible, promising step toward getting health care costs under control.<\/p>\n

\u201cIt\u2019s not bad economics, it\u2019s good economics\u2014it\u2019s letting the market work until it doesn\u2019t,\u201d MIT economist Jonathan Gruber<\/a>, who played a key role in shaping the Affordable Care Act<\/a>, told me. \u201cThis is the lesson I teach my students in basic economics: You trust markets until markets stop working. And at that point, you start to think about regulation.\u201d<\/p>\n

THE OTHER BIG WAY THE CAP PROPOSAL envisions breaking with status quo thinking is by limiting the ability of insurers to restrict access to care by requiring approval in advance\u2014or, as it\u2019s known in the business, \u201cprior authorization.\u201d<\/p>\n

If you\u2019ve ever had to see a specialist or get a procedure, you\u2019re probably familiar with how difficult this process can be. It\u2019s been the rule rather than the exception ever since the 1990s, when private insurers adopted the practice as a way to scrutinize health care decision-making.<\/p>\n

The theory behind it was that the old system, in which insurers paid for whatever doctors ordered up, created incentives to seek and get care that might be unnecessary or even harmful. Prior authorization represented a strategy for deterring that practice, in a way that would not only improve care but hold down costs. And there\u2019s certainly evidence it\u2019s worked that way, at least some of the time.<\/p>\n

But there\u2019s also evidence that prior authorization can push health care spending higher, by adding a bunch of costly administrative work. And that\u2019s not to mention the potential for insurers to apply standards arbitrarily or excessively. They can deprive people of care they actually need to stay healthy\u2014which can, as a side effect, increase overall health care spending by creating even worse medical problems in the future.<\/p>\n

Prior authorization \u201ccan powerfully delay coverage, and sometimes deny coverage outright,\u201d said Miranda Yaver<\/a>, a University of Pittsburgh health policy professor whose forthcoming book, Coverage Denied<\/a>, examines how prior authorization veered from its original purpose.<\/p>\n

The CAP plan proposes to change these practices\u2014in part, by prohibiting prior authorization altogether for certain kinds of emergency, routine, and chronic care, as Massachusetts<\/a> recently announced it was doing. Insurers could still review other kinds of claims. And for the types of care that data shows are frequently overused (like some kinds of back surgeries<\/a>) the insurers could still review claims before payment. But they\u2019d have to run it through outside organizations that follow clinical guidelines.<\/p>\n

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Like CAP\u2019s proposals for regulating hospital and insurance prices, the proposals to change prior authorization leave lots of unanswered questions\u2014like precisely what would qualify as an emergency case exempt from review. And here too, it\u2019s easy to imagine analysts from a variety of perspectives raising serious concerns\u2014including whether, by taking away a tool insurers have used to hold down health care spending, this proposal might actually drive up costs.<\/p>\n

But one of the experts CAP consulted on the proposal is Zirui Song<\/a>, who in addition to being a health policy professor at Harvard is also a practicing physician. And one thing he likes about the proposal, he told me, is the way it recognizes that different sorts of care call for different sorts of scrutiny.<\/p>\n

\u201cWhen I think about improving the system of prior authorizations, it\u2019s less of a yes or no [question] . . . and more about making sure decisions align with the clinical evidence base,\u201d Song said.<\/p>\n

ULTIMATELY THE CHALLENGE in attempting to translate something like the CAP policy into legislation isn\u2019t just about getting the policy right. It\u2019s figuring out the politics too. And as much as this proposal is designed to meet the moment, by addressing worries about costs that voters say are a<\/a> top<\/a> concern<\/a>, it would almost certainly run into stiff resistance from insurers and hospitals.<\/p>\n

But industry opposition isn\u2019t always insurmountable. Just a few years ago, Joe Biden and the Democrats managed to enact new regulations<\/a> on prescription drug prices, despite hard-core pushback from the pharmaceutical industry.<\/p>\n

It helped that the idea was inherently popular. But it also helped that the process of crafting that legislation started years before<\/a> Biden took office, because it meant there was time to work out the substance and the presentation. Something similar could be starting now.<\/p>\n

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