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The Keckley Report

An Open Letter to the Senate HELP Committee

By August 7, 2017March 1st, 2023One Comment

To Senator Lamar Alexander, Chairman and Senator Patty Murray Co-Chairman, Committee on Health, Education, Labor and Pensions Committee, United States Senate, Washington DC

As you begin your deliberation next month to stabilize the individual insurance market for those who obtain coverage through the health exchanges, might the committee take the opportunity to address access and trust in the U.S. health system in tandem?

Polls show Americans are fed up with political speak, one-sided arguments, policy-by tweet and short-sighted policy-making aimed at election gains over meaningful solutions. We’re divided as a country more than ever and issues about the future of the health system are at the center of the public divide.

The stability of the individual insurance market is an urgent issue. No doubt, valid arguments will be made about raising the risk band from 3:1 so premiums for younger, healthier citizens are lower. Funding of the cost sharing subsidies at least through 2018 and giving states flexibility in the administration of their marketplaces makes sense. And finding ways to discourage lapses in coverage and increase participation among eligible young invincibles need fresh thinking.   

But the individual insurance market is only 4% of the 285 million who are insured. Other issues relative to insurance coverage need attention lest the problems reappear: how to encourage voluntary participation among those not eligible for financial subsidies, how to address premium spikes that price these plans out of reach for the healthy, how to insure the 10% in our population unable to purchase coverage due to pre-existing conditions, how to create greater transparency about insurers’ accountable coverage and denial policies and procedures, and how to assure that insurers play fair with providers—the doctors and hospitals that bear the brunt of insurance lapses that result in slow reimbursement or none and others.

The majority of us do not care whether you call your process Repeal, Replace, Repair or Re-do. And we think health reform is about more than fixes to the insurance market. We care about the health system: is it serving the needs of our population responsibly and efficiently? Are clinicians accessible and competent? Is the $10,000 we spend per man, woman and child used appropriately? Is wasteful spending from redundant paperwork and unnecessary care being attacked aggressively so savings can be invested in systemic improvements and increased access? Are the social programs we offer worth the $3000 extra we spend, and are they linked appropriately to systems of health in every community? Are we encouraging healthy living via policies that make primary care more accessible to the 25% who lack any relationship with a physician, nurse practitioner, dentist, mental health professional? And what about the lethal explosion of emergency room use, drug costs and the opioid use—all reflective of fault-lines in the system where a cogent national strategy is missing?

There’s merit in hearing from those who bring solutions to these issues. The trade associations have been articulate in pointing out flaws in the ACA and advancing their views about remedies. But as is the nature of our democracy, their self-interests sometimes override the public’s interests. And frequently, their focus is too narrow.

As chairs of this important committee, it is your obligation to serve the interests of citizens in every stage of life, regardless of health status, economic circumstance and political leanings. I trust you’ll take this opportunity to hear fresh perspectives about solutions aimed at protecting the facets of the health system that work well while fixing those that don’t. The stability of individual insurance market is a legitimate issue but it’s small relative to policies and strategies that impact every employer and household. Your charter must be bigger than reducing risks for insurers; it must be about the viability and sustainability of the entire health system.


P.S. In the spirit of full disclosure, I have known Lamar Alexander since 1974. I have contributed to his campaigns because I respect his judgement and independence. I have voted for and contributed to elected officials in both parties through the years. As a Tennessean, I regard Lamar as a friend and statesman and am gratified he and Senator Murray are embarking on this important process.

Healthcare’s in the news: Thursday, the Senate gave final approval to legislation to finance one fourth of the FDA’s operating budget through fees paid by drug and device manufacturers and a separate bill (Right to Try Act) expanding access to experimental treatments for people with terminal illnesses….Friday, the Federal District Court in Brooklyn, convicted former Turing CEO Martin Shkreli on 3 of 8 counts of securities and wire fraud related to two hedge funds he ran, MSMB Capital and MSMB Healthcare. Prosecutors charged he illegally used a pharmaceutical company he founded, Retrophin, to repay defrauded MSMB investors. The 34 year old gained prominence after raising the price of a drug called Daraprim by more than 5,000%–$750 per pill, up from $13.50…. And at the end of the week, at least three new reform proposals to replace the ACA were being circulated by Senators Sanders, Cassidy, Collins and Graham. Stay tuned.

One Comment

  • Scot Adams says:

    As usual you hit the nail on the head, Paul. In addition I encourage all to consider the enormous impact of behavioral health – beyond the current opioide crisis – on the healthcare system.