Moving to the next phase of health care reform

A view of the Capitol Building in Washington October 15, 2013.
Editor's note:

This report was originally published in the Journal of Law, Medicine and Ethics on December 20, 2016.

We have two general goals in the continuing process of health care reform. The first is to widen effective insurance coverage while also seeking to control costs. But the second is to spur improvements within the health system by encouraging local innovation and addressing the social determinants of health – the nonmedical factors that influence health, such as socioeconomic status, employment, and housing conditions. While a multi-sector strategy is technically difficult, there is broad bipartisan support for it: empowering local institutions – de Tocqueville’s “little platoons” – and breaking down regulatory and budgetary silos to address problems appeals to both left and right.

How can we best achieve this second goal? Waivers and demonstration or pilot programs are the most common tools in use. But we can go much further to build a culture of health in communities by bringing together the energy and resources of different sectors. That requires action on three broad fronts:

  • Expanding waivers. Section 1332 of the Affordable Care Act provides broad opportunity for states to mix healthcare programs and funds together in creative ways.
  • Encouraging agencies to work together. From the federal government down, successful multisector strategies require agencies to plan together, and to braid or blend funding. Some federal agencies and some states have been making progress in such collaboration.
  • Fostering local initiatives and partnerships. Policymakers can help foster initiatives at the local level by encouraging and strengthening hub institutions and facilitating partnerships.

Read “Moving to the Next Phase of Reform