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Obamacare expanded health access. Now supporters want another bill to tackle costs.

Obama signs his health-care reform bill into law. (Marvin Joseph-Washington Post) Obama signs his health-care reform bill into law. (Marvin Joseph/The Washington Post)

Five health policy wonks walk into a room and start talking about how to bend the health-care cost curve — stop us if you've heard this one before.

Plans to bend the health-care cost curve are pretty plentiful in the nation's capital. Lots of think tanks and coalitions have plans to cut billions (even trillions) in health-care spending.

The Partnership for Sustainable Health Care argues it's something different. The new alliance, which includes health plans, a hospital and consumer advocates, isn't looking to bring fresh ideas to the debate. It recognizes this city has no shortage of think tank proposals.

Instead, the Partnership wants to start putting political muscle behind the ideas that already exist — and, after it does that, pass legislation that would control health-care costs in a way the Affordable Care Act doesn't.

"One of the things we've all learned from decades of painful experience with health-care reform is that these are very powerful interests," Families USA Executive Director Ron Pollack says. "If they're not bought in, we're not going to achieve significant change.

"What we think we're doing that's unique is we're going to reach out to those key parties and key sectors. If we're successful, we'll lay the basis for a comprehensive, thoughtful approach to dealing with costs and quality."

The group has met for just over a year now and includes some of the  same interests that supported the Affordable Care Act, such as America's Health Insurance Plans, Families USA and Ascension Health, the largest Catholic hospital system in the country.

While all support the Affordable Care Act, they tend to agree that additional legislation will be necessary to control health-care costs.

"The Affordable Care Act takes some significant steps with respect to cost," Pollack says. "None of us are fooling ourselves that the enormous contribution of the health law is on coverage."

The group released Thursday morning a five-pronged proposal that it will now begin reaching out to other health-care stakeholders. Much of it does indeed look familiar to those who have followed the health-care debate. It proposes tethering doctors' payments to value, factoring cost-effectiveness into what treatment plans cover and setting better quality metrics to measure what counts as top-notch health care.

"This is not a time where we're trying to create a branded, unique new idea on the table," Pacific Business Group on Health President David Lansky says. "We're trying to describe, around a shared vision, what is possible. It's critical that the country move forward to address these issues, and the way to do that is by getting broad agreement."

The Partnership is not, at this point, focusing on legislative action — it wants to build a bigger base of support before it heads to Capitol Hill. At some point though, it does see a need to pass yet another health-reform bill, one that would focus more on controlling costs than expanding access.

John Rother, who heads the National Coalition on Health Care, sees space for movement later this year, when Congress is likely to take up "doc fix" legislation, to keep Medicare payments stable.

"There will be opportunities," he says. "Most notably with the expiration of the SGR [sustainable growth rate] coming up at the end of the year, there are going to be opportunities to use these ideas to move the process forward."

How much support the new Partnership gets remains to be seen. One of the most difficult groups to recruit may be health-care providers; when we talk about cutting health-care costs, we're also talking about cutting how much we we pay doctors and hospitals.

It has, however, already recruited Ascension Health. CEO Robert Henkel came on board with the group because he wants more uniformity on how his providers get paid. While there's some movement toward paying doctors for value, the future course looks unclear — and that makes it difficult for a hospital to plan for the future.

"We are experiencing the chaotic environment of living in the two worlds of fee-for-service and [paying for value]. That is a difficult challenge and becomes even more difficult over time. Our inability as a system, to move to the value component more quickly, puts us at risk for achieving the transformation that's so necessary in this country."



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Ezra Klein · April 11, 2013

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