A Health Policy Agenda for the 118th Congress

Congress should advance solutions that put patients and families in control of their health care decisions. Codifying several Trump administration rules would allow more flexible and affordable coverage arrangements and empower Americans to better navigate the onerous heath care bureaucracy. These rules include price transparency requirements on hospitals and health insurers to provide upfront and actionable price information, an expansion of Association Health Plans so small businesses can gain the same regulatory advantages in offering coverage that large employers receive, an expansion of affordable and flexible short-term health insurance plans, and flexibility to allow employers to offer health reimbursement arrangements through which workers use their employer contributions to purchase individual coverage that works best for them.

By increasing affordable coverage options, these solutions will help ease the burden of the current inflation crisis that American families now face.

Tackling the growing consolidation in the health care industry could also alleviate high prices while maintaining or even improving quality of care. Hospital consolidation is particularly notable because it is not correlated with better care and often leads to higher prices.¹ Flawed federal programs have produced consolidation in the health care market, so Congress should ensure that any solutions address these root causes. For example, Congress should enact site neutral payments in Medicare, remove problematic programs like Obamacare’s Medicare Shared Savings Program, and reform the 340b Drug Pricing Program.

Trust in public health is at historic lows, given the growing belief the public health agencies have become overly political.¹⁷,¹⁸ This distrust undermines the work these agencies do and the effectiveness of their guidance. Multiple studies have shown that such distrust has increased hesitancy about not only the COVID-19 vaccine but other vaccines as well.¹⁹ While the CDC is engaging in damage control for its tarnished image, true reform must address the aforementioned mission creep at the agencies.²⁰,²¹ Effective congressional oversight is just one step to restoring public trust in public health. A robust legislative reform agenda is also needed.

Next year, the Pandemics and All-Hazards Preparedness Act (PAHPA) will expire. PAHPA reauthorization will be a natural opportunity for a needed conversation about reforming our public health agencies. Congress should reform not only the agencies, but also the process by which those agencies are authorized and funded. The CDC has no single overall authorizing law, and the NIH has not been reauthorized since 2006, which was also the last time it underwent substantive congressional review and eventual reform. Instead Congress asserts control over the agencies through the appropriations process or occasional amendments to the Public Health Service Act and other statutes.

Congress should rethink these agencies from the ground up. The CDC should be reformed to be a more nimble, efficient, thoughtful agency that focuses on reducing the risk of communicable disease. Only through such reform can the agency be restricted from advancing non-germane, woke priorities addressing everything from climate change to gender identity.²²

To accomplish such needed reform, Congress should ensure the CDC’s role is properly defined. Further, Congress should lay out a center-by-center authorization of the agency, reform its emergency powers, cut redundant activities, and reassign functions that may be carried out better by other agencies. Activities that state and local governments are best equipped to do should not be crowded out by federal actions. States are often situated to respond to their citizens’ public health needs more efficiently. The pandemic highlighted how broad federal recommendations are not always best for individual states.

Congress should also consider reforms needed at the NIH. What once started as a single institute has proliferated into 27. While the NIH has garnered bipartisan support for much of its existence, scientific groupthink has led to growing frustration and a centralization of public-funding.²³ Dissenting views are easily cast aside, which is unsurprising given that the most taxpayer dollars are granted to a small subset of educational institutions. The NIH should be reformed to ensure the science it funds efficiently serves the public interest.

Finally, the 118th Congress should prepare to engage on substantive FDA reforms. While such reforms will not be enacted for five years, the user-fee authorization process which forms the basis of the FDA’s activities require an in-depth understanding and stakeholder buy-in. Policymakers should begin outlining a vision for what that reform will look like in the upcoming Congress.

The unsustainable trajectory of federal health programs—Medicare, Medicaid, and Obamacare—is one of the most important priorities for Congress to address. These programs are significantly contributing to federal deficits and the national debt and thus higher interest rates and inflation now. And without reform, these programs will cause a much lower standard of living for Americans in the future.

While improper payments in Medicaid are a huge problem, the Medicare program faces the most severe financing challenges. The program is increasingly relying on general revenue, which now finances 46 percent of the program.²⁴

Moreover, the most recent Medicare Trustees report indicated that the Medicare Hospital Insurance (HI) Trust Fund is projected to be depleted in 2028, which would lead to a 10 percent payment cut in 2028 with rising payment reductions thereafter.²⁵ In other words, no plan means an across-the-board payment cut. Since the 1970s, Congress has always acted to address projected insolvency within five years of reaching such a projection, so Congress will almost certainly need to begin this discussion within the next two years.

The 118th Congress will have opportunities to reform government programs in ways that improve the experience of patients and their families. Congress should focus on an anti-inflationary agenda that incorporates lessons learned from the policy failures of the last two years and ensures that any solutions put the needs of patients and families above the bureaucracy and special interests. To do so will require effective oversight of both the government failures in its COVID-19 response and the growth of government control over Americans’ health care. Effective oversight will help lay the groundwork for needed policy reforms.