Employer groups call on Congress to ensure quality, affordable health care

The Pacific Business Group on Health (PBGH), along with several other organizations, sent a letter to congressional leadership on Tuesday outlining recommendations to ensure Americans have access to quality, affordable health care during and after the COVID-19 pandemic.

PBGH represents private employers and public purchasers that collectively spend $100 billion annually on health care services for over 15 million Americans. The letter is also signed by 35 other private and public sector employer groups across the country.



In their letter to Congress, the organizations note that nearly 30 million Americans have lost their jobs in the last several weeks due to the COVID-19 public health emergency. The letter states that the potential resulting recession may be deep and prolonged.

To ensure access to health care during and after these difficult times, the organizations divided their recommendations into four categories:

1. Providing affordable coverage in the immediate and longer term: To provide affordable coverage to newly unemployed individuals, along with the millions of people who were uninsured before COVID, the letter recommends Congress take steps to increase telehealth coverage and care during the crisis. This includes eliminating state barriers to care, allowing patients to see out-of-state providers, and offering telehealth as a standalone benefit.

The letter also makes recommendations to ensure sufficient COBRA subsidies and asks that Congress pair long-term health coverage policies with actions that reduce health care prices and increase value for all payers.

“Our health care system is rife with unnecessary spending, poor resource allocation, and unsustainably high prices. As the primary private and public sector payers for health care, we are deeply concerned that the long-term outcomes of COVID-19 could be an even more rapid increase in prices and greater health care industry consolidation,” reads the letter.

2. Ensuring access to primary care clinicians: In an effort to support primary care clinicians facing financial hardship during the crisis, the organizations recommend providing immediate financial assistance to primary care providers on top of what was approved in the CARES Act. They also recommend expanding opportunities for practices to participate in value-based prospective, population-based payment models that increase investment in primary care, and mandate that provider organizations agree to not engage in mergers and acquisitions of other provider organizations for 12 months in order to receive CARES Act funding.

These reforms are especially critical to ensuring the long-term viability and survivability of smaller physician practices. As these smaller practices struggle and threaten to close because of this pandemic, we fear this could exacerbate already problematic provider consolidation – giving even more market domination to physician staffing firms and other parties already positioned to command exorbitant prices.”

3. Stopping price gouging and protecting patients from surprise bills: For required COVID-related services that must be provided without patient cost sharing and that are provided out-of-network, the letter recommends mandating they be paid at the Medicare fee schedule. They also call on lawmakers to explicitly ban price gouging on health services and equipment and to prioritize banning surprising billing.

4. Mitigating risk in the health insurance market: The letter references an analysis from Covered California that found that the cost of coverage for COVID-related services could surpass $250 billion. This creates uncertainty in both the short-term and long-term, resulting in health plans potentially needing to substantially increase premiums to offset the risk of higher costs.

“Congress should enact policies that protect insurers and self-insured employers from unexpected costs in the 2020 and 2021 plan years. Such policies could include a reinsurance mechanism or one-sided risk corridor, which would “kick in” only if costs exceed a certain threshold. By providing protection against the risk of significantly higher prices and demand, policymakers will reduce the chance of future premium spikes by insurers.”

Joining the Pacific Business Group on Health in signing the letter were organizations such as Colorado Business Group on Health, DFW Business Group on Health, Silicon Valley Employers Forum, Texas Business Group on Health, and the Washington Health Alliance.

“Large employers have grave concerns about the unprecedented strain the COVID-19 pandemic is placing on our health care system and its impact on the ability of millions of Americans to get the medical care they need now and in the long-term,” said Elizabeth Mitchell, president and CEO of Pacific Business Group on Health in a prepared statement.

“The COVID-19 crisis has exposed the pre-existing failures of our health care system and reinforced the fact that our physical and economic health are inextricably linked,” Mitchell continued. “The current situation must be a catalyst for expediting the reforms that have been needed for years. Doing so is essential not only to ensuring the health of our citizens, but also to restoring our economy. We are urging Congress to take bold action now.”