BPC would like to thank the Robert Wood Johnson Foundation for its generous support.
In 2017, the Bipartisan Policy Center launched the Future of Health Care Initiative with a bipartisan group of leading national policy experts to create a consensus approach to improving our nation’s health care system, increasing access to affordable insurance coverage, improving quality of care delivered to patients, lowering costs for all Americans, and creating competition throughout the health care sector. In response to the COVID-19 pandemic, the leaders turned their attention to improving the nation’s public health infrastructure and preparing for the next pandemic.
In January 2021, the Future of Health Care leaders released a report outlining high-priority immediate actions that the administration and Congress should take in combating COVID-19, and in June 2021, the leaders released recommendations to ensure that our public health system is well-prepared to respond to and mitigate the consequences of a future pandemic. These recommendations provide a strategic approach to bolstering our nation’s public health infrastructure. However, to fully address our vulnerability to health threats, we must confront the underlying challenge of the poor health status of the U.S. population.
Compared with many other industrialized nations, the United States invests significantly less in disease prevention and social services. Rather, health care spending is directed toward the delivery of health care services to treat chronic conditions. As has been noted in previous reports, early investments in programs and services that address social determinants of health could help avert the onset of chronic conditions. Some of our leaders would like to see federal health insurance programs, such as Medicare and Medicaid, play a role in preventing the onset of chronic conditions resulting from social needs. At the same time, a number of our leaders have concerns about using health insurance programs to address shortfalls in funding for social services. This report seeks to strike a balance between those two competing interests.
Recognizing the need to better bridge the divide between the often-siloed worlds of health and health care, these policies are designed to better integrate, coordinate, and ultimately improve the performance and outcomes of both. Our recommendations focus on two key areas: 1) improving access to and coverage and financing of non-medical and preventive services; and 2) the health care workforce, with a focus on increasing access to care through improvements in the supply and distribution of key practitioners who are needed to improve the health status in underserved communities.
Specific recommended actions include:
Improving Access to and Sustainable Financing of Nonmedical and Preventive Services
A. Coverage of Non-medical Services in Medicaid
A. Provide the secretary of Health and Human Services (HHS) with the authority to expand Medicaid coverage of nonmedical services that address social needs and community-based interventions. For individuals participating in value-based payment models, including fully capitated managed care, accountable care organizations, or health homes:
- The secretary could authorize coverage of nonmedical services where evidence demonstrates the benefit improves or maintains health outcomes for a defined population.
- The secretary could authorize Community Preventive Services Task Force (CPSTF) recommended interventions that have either “strong” or “sufficient” evidence, are cost-effective, and are appropriate to be covered under Medicaid (e.g., not room and board). Examples include:
- Various cancer screening interventions that engage community health workers
- Community-wide physical activity campaigns
- HHS should provide funding for ongoing studies by the Congressional Budget Office (CBO) and Government Accountability Office (GAO) on the cost and benefit of such services.
B. Expanding Access to Preventive Services in Medicaid
- Require coverage of clinical preventive services without cost-sharing in Medicaid for the non-expansion population. From BPC’s 2020 Advancing Comprehensive Primary Care in Medicaid report
- Direct the secretary of HHS to provide CMS guidance to states on defining and reimbursing community health workers within their Medicaid programs, where evidence has demonstrated improved outcomes. From BPC’s 2020 Advancing Comprehensive Primary Care in Medicaid report
Increasing the Capacity of the Health Care Workforce to Support Integration
- Waive the federal requirement for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) providers to be licensed in the state where a patient receives services, when the provider is licensed in another state; and issue FBI guidance to states drafting interstate licensure compact legislation.
- Use technology to enable greater integration of clinical and community-based services.
- Improve Medicaid reimbursement for primary, prenatal, and postpartum care. Congress should increase state Federal Medical Assistance Percentages (FMAP) to 90% for five years for primary, prenatal, and postpartum services for states that reimburse those services at certain minimum rates; states must reimburse primary care services at Medicare rates and reimburse prenatal/postpartum services at average commercial rates to receive the enhanced FMAP. Congress should also direct GAO to study and report on the impact of the increased reimbursement rates on access to care.
- Appropriate funding for the National Health Care Workforce Commission to perform a comprehensive evaluation of the current workforce landscape, develop policy recommendations to ensure federal education and training programs meet critical needs, and provide oversight of federal workforce programs.