Democratic ally lays out health affordability plan

Driving the news: The Center for American Progress plan released this week aims to lower health care costs, including premiums and deductibles, and ban insurers from requiring pre-treatment approvals.

• It concurrently released new polling and a memo making the case that voters want immediate cost relief — and that the "old debate about the structure of our health system is less important than making health care more affordable as soon as possible."
• "There has not been sufficient focus on just how much costs are driving people's concerns around health care," center CEO Neera Tanden, a top Biden White House official, said in an interview.
• "People are looking for answers now. Not five years from now, not 10 years from now, but now."

The big picture: CAP's argument — or at least its broad contours — is bolstered by independent polling and is already being made by some congressional Democrats as well.

• Health care topped the list of domestic concerns in recent Gallup polling, with 61% of respondents saying they worry a great deal about its availability and cost.
• Lawmakers in both parties also are increasingly critical of the business practices of health insurance companies and, at times, providers.
• But the Democrats' new emphasis on cost drivers and affordability for the insured population is a shift from their decades-long quest to expand coverage.

Details: The CAP plan has four main components:

• Setting up a federal rate review process that presumes any premium increases above general medical cost trends are excessive.
• Limiting hospital prices in "concentrated markets" to no more than three times what Medicare pays, and capping price growth for those hospitals that charge above the statewide median.
• Overhauling the Affordable Care Act's "medical loss ratio" so that insurer profits won't rise when costs are higher, but are instead limited either by a cap per enrollee or to a percentage of premiums collected for a market.
• Banning prior authorization reviews and replacing them with an independent clinical review process.

Between the lines: The proposal "really responds to the extreme consolidation of the health insurance industry and the hospital industry," said Topher Spiro, a senior fellow at CAP and the lead author of the report.

• "That excessive consolidation or concentration is really what's driving up prices and premiums. It's not a mystery that that's the cause, so the solution needs to address it," he added.
• The report proposes a short-term guardrail around insurers paying pharmacies and providers they own, and endorses breaking up such health care conglomerates in the long run.

The other side: Insurers and hospitals adamantly reject accusations of profiteering, citing factors they say are largely out of their control for the steady increase in health care costs.

• Both would undoubtedly fight any substantive efforts to make the kind of changes proposed by CAP, saying they would threaten patients' access to care.

The intrigue: The proposal doesn't call out the efforts of blue states like California and New York.

• Instead, it name-drops Indiana and Arkansas, conservative-led states that have made efforts to limit hospital prices and bar pharmacy benefit manager ownership of pharmacies.

What we're watching: Though influential among Democrats, CAP is still a think tank. The real question is what solutions elected Democrats and presidential hopefuls start pushing in the coming months.

• "In the face of both Republican attacks and rampant profiteering by giant corporations, it's clear that making health care affordable for American families is going to be an all-hands-on-deck effort," said Sen. Ron Wyden of Oregon, ranking Democrat on the Senate Finance Committee.