Senate Democrats lay out health insurance redesign targets

• It shows in broad strokes how the party is grappling with what can be done about private insurance, not just how to create more government-run coverage.
• It's designed for when Democrats next have total control of power in Washington, which would be 2029 at the earliest.

Driving the news: The group of Senate Democrats — led by Finance Committee Ranking Member Ron Wyden — released an 86-page request for feedback from stakeholders and policy experts on dozens of policy goals aimed at making private insurance more affordable and user-friendly.

• It makes clear that at least some members of the party want to open a new chapter in Democrats' health care policy agenda — one that's responsive to the system as it is today, including recent changes made under the Trump administration.
• "Beyond simply reversing cuts, Democrats are committed to reimagining what a coverage system must look like moving forward and enacting new reforms so that every American is not only covered, but can access, afford and receive care when they need it," the white paper states.

Between the lines: Democrats have been consumed for years with the question of how far to expand government-run insurance, with the party deeply divided over Medicare for All, an idea that could lead to the total abandonment of private insurance.

• The Senate Democrats' latest effort seeks a middle ground. It includes a section on the expansion of public insurance and a "Medicare-type choice," but devotes more real estate to the question of how to make private insurance work better.

Details: For example, it asks whether and how to limit patient out-of-pocket spending, including through deductibles and coinsurance.

• It asks for feedback and recommendations on "affordable caps on total spending, inclusive of premiums, deductibles and cost-sharing" and "a uniform approach to capping cost-sharing based on affordability."
• It also discusses expanding federal power to review premium increases.

Our thought bubble: Its inclusion of employer insurance is particularly noteworthy. Workplace insurance covers a much larger portion of the country than Affordable Care Act marketplaces, but has been left alone in recent major health care efforts.

The intrigue: The final section of the paper is titled "taking on corporate greed" and squarely targets insurers' business practices, probing ways to rein them in.

• It takes aim at third-party administrators and other "middlemen" owned by insurers, arguing they "extract profit using practices similar to those used by pharmacy benefit managers (PBMs)."

Yes, but: Almost no one thinks health care's affordability issues can be solved solely through insurance reforms.

• Though Wyden and other Democrats are eager to further target prescription drug prices, there's no similar effort to address hospital and provider spending.

What they're saying: "We welcome any opportunity to discuss common-sense solutions to improve outcomes, expand access and lower costs for everyone," Chris Bond, a spokesperson for America's Health Insurance Plans, said in a statement when the effort was first launched.

• "We welcome the opportunity to work with regulators and policymakers to set the record straight around these market dynamics, avoid unintended consequences, and ultimately improve consumer experience and affordability," CVS said in a statement.

What we're watching: A Finance Committee aide told reporters that the hope is to start fleshing out specific policies next year.

The bottom line: If Democrats are serious, insurers could be in big trouble — and patients could be looking at, at minimum, a serious discussion about the things they hate most about insurance.