As the newly-elected 119th Congress readies to tackle a list of legislative priorities, Purchaser Business Group on Health (PBGH), a nonprofit coalition representing 40 private employers and public entities across the U.S., shares a new Brief detailing its health care policy priorities. PBGH members share bi-partisan goals to reduce health care costs while improving quality and access of health care services. PBGH members lead innovative purchasing strategies but need policy change to enable a functional health care market.

“We welcome the new Congress and Administration’s willingness to disrupt an industry that has become increasingly consolidated, unresponsive and dysfunctional,” said Elizabeth Mitchell, President and CEO of PBGH. “The current system does not work for employers, families or most health care providers and the industry has demonstrated it will not reform itself to deliver high quality care at lower costs. Legislative action is needed to curb anticompetitive practices and enable accountability.”

To improve affordability, the Brief identifies specific policy actions for Congress and the Administration, including:

• Lower Health Care Costs by addressing hospital and drug pricing, limiting consolidation, and prohibiting anti-competitive practices.
• Improve Data Access and Transparency by enforcing hospital price transparency and transparency in coverage regulations and enhancing penalties for non-compliance.
• Enact Service Provider Reforms by ensuring PBM and TPA transparency, including reporting drug pricing data and prohibiting gag clauses, and extending fiduciary obligations to service providers.
• Support Direct Contracting and Joint Purchasing by clarifying antitrust guidance allowing multiple employers to join together, and ensuring direct contracts are covered by ERISA’s preemption law.

Many of these policy recommendations are important to enable employers’ ability to meet their fiduciary responsibilities on behalf of employees and families.In addition to affordability, the Brief offers recommendations on improving access to needed high-quality care. PBGH supports efforts to:

• Improve Maternal and Child Health ensuring access to safe and high quality maternal and post-partum care – especially in rural areas – through a whole person approach and expanding access to care teams including midwives and doulas.
• Improve Primary Care and Mental Health by removing barriers to advanced primary care, investing in the primary care workforce, and integrating mental health care into primary care.

“The health care market is broken. These common-sense reforms will go a long way toward establishing fair competition and greater transparency will allow the marketplace to work to better control costs and improve access to high quality care,” Mitchell said.

About Purchaser Business Group on Health

PBGH is a nonprofit coalition representing nearly 40 private employers and public entities across the U.S. that collectively spend $350 billion annually purchasing healthcare services for more than 21 million Americans and their families. In partnership with its members, PBGH initiatives are designed to test innovative operational programs and scale successful approaches that lower healthcare costs and increase quality across the U.S.

Janet Cabibbo
Purchaser Business Group on Health
415-615-6344
jcabibbo@pbgh.org