Opinion: Health Costs and Financing

Challenges And Strategies For A New Administration

It is likely that 2021 will be a dynamic year for US health care policy. There is pressing need and opportunity for health reform that helps achieve better access, affordability, and equity. In this commentary, which is part of the National Academy of Medicine’s Vital Directions for Health and Health Care: Priorities for 2021 initiative, we draw on our collective backgrounds in health financing, delivery, and innovation to offer consensus-based policy recommendations focused on health costs and financing.

We organize our recommendations around five policy priorities: expanding insurance coverage, accelerating the transition to value-based care, advancing home-based care, improving the affordability of drugs and other therapeutics, and developing a high-value workforce. Within each priority we provide recommendations for key elected officials and political appointees that could be used as starting points for evidence-based policy making that supports a more effective, efficient, and equitable health system in the US.

It is likely that 2021 will be a dynamic year for US health care policy. More than a decade after the Affordable Care Act (ACA) was passed, health reform remains a top concern for the American public. The number of uninsured Americans is rising. Affordability—at both the system and individual levels—is eroding. And the numerous ways in which racism and prejudice drive unacceptable disparities in health and well-being are increasingly evident. The coronavirus disease 2019 (COVID-19) pandemic, which placed historic stress on an already strained system, has only exacerbated many of these shortcomings.

Against this backdrop, the National Academy of Medicine convened the Vital Directions for Health and Health Care: Priorities for 2021 initiative, which, following a 2016 initiative of the same name, aims to provide expert guidance on several focus areas for US health policy. In this article we draw on our collective backgrounds in health financing, delivery, and innovation to offer a set of consensus-based policy recommendations focused on health care costs and financing.