Key policy priorities
– Prescription drug pricing: Lawmakers and regulators are pursuing tools to lower out-of-pocket costs and bring down list prices.
Options being used or proposed include enabling negotiation for drugs covered by public programs, promoting generic and biosimilar competition, capping inflationary price increases, and increasing transparency around manufacturer pricing and rebates.
– Price transparency and surprise billing: Rules requiring hospitals, insurers, and providers to disclose prices and prevent surprise out-of-network bills aim to give consumers clearer expectations and limit unexpected financial harm. Effective enforcement and user-friendly disclosure tools are essential for these rules to meaningfully influence consumer decisions.
– Telehealth and digital care: Expanded telehealth access has improved convenience and continuity of care, especially in rural and underserved communities. Policy decisions now center on payment parity, quality standards, cross-state licensure, and ensuring equitable broadband access so telehealth reduces disparities rather than widening them.
– Value-based payment and primary care investment: Shifting from fee-for-service to value-oriented payment models can incentivize prevention and care coordination.
Strengthening primary care, behavioral health integration, and social needs screening can reduce avoidable hospitalizations and total cost of care.
– Medicaid and coverage stability: States that expand or enhance Medicaid coverage see gains in access, particularly for low-income adults. Policy tools that improve enrollment continuity and support community-based services can reduce churn and avoidable emergency care.
– Workforce and equity: Provider shortages—especially in primary care, mental health, and obstetrics—contribute to access gaps. Policies that support training, loan forgiveness for service in high-need areas, and task-shifting to advance practice clinicians can help close those gaps. Concurrently, addressing racial and socioeconomic disparities in outcomes must be central to any policy agenda.
What works best
Policy interventions tend to be most effective when they are multi-pronged. For example, lowering prescription drug costs benefits from combining negotiation authority with accelerated generic approvals and better rebate transparency. Expanding telehealth benefits requires parallel investments in broadband, digital literacy, and privacy standards.
Price transparency rules need clear enforcement and consumer-friendly tools to be useful at the point of care.
Practical recommendations for stakeholders
– Policymakers: Prioritize enforcement mechanisms for transparency rules, support payment reforms that reward outcomes, and invest in workforce pipelines and broadband infrastructure.
– Providers and health systems: Adopt value-based contracting incrementally, invest in care coordination and social needs screening, and engage in price transparency tools that help patients shop when appropriate.
– Employers and insurers: Promote benefit designs that encourage primary care use and preventive services, and explore alternative payment models that align incentives across providers.
– Patients and advocates: Use available price tools and appeal processes, engage with care teams about lower-cost alternatives, and advocate for policies that expand coverage and reduce surprise bills.
The health system is complex, but targeted policy choices can bend the cost curve and improve access without sacrificing quality. Thoughtful implementation, strong enforcement, and attention to equity will determine whether reforms deliver better care for all. Policy choices made now will shape access, cost, and quality for the long term.