Blue Cross Blue Shield Association Policy Solutions Could Lower Health Care Costs by $767 Billion

Affordability Solutions for the Health of America focus on improving competition, lowering prescription drug costs and prioritizing high-quality care

WASHINGTON – Today, the Blue Cross Blue Shield Association (BCBSA) released policy solutions that could reduce health care costs in the United States by $767 billion over 10 years. The recommendations, Affordability Solutions for the Health of America, address the root causes of rising health care costs by improving competition, lowering prescription drug costs and prioritizing high-quality care.

The reason for this affordability crisis is clear: rising prices for health care services and prescription drugs. According to the Health Care Cost Institute, health care prices increased from 2016-2020 at roughly double the rate of general inflation—with prices being the primary driver for higher health care spending. In 2021, the average premium for an employer-provided family health insurance policy reached $22,221—one third of the median household income.

Rising costs for consumers are a significant consequence of the rising price of health care delivery. As hospitals continue to acquire physician practices, the result is often using reimbursement to maximize revenue and drive higher prices. Additionally, soaring drug prices are brought on by steep launch and list prices, and drug manufacturers delaying generic and biosimilar medications from going to market. Families feel the consequences of higher prices every day through higher premiums and out-of-pocket costs. This is because the cost of health insurance is driven by the cost of health care.

“We must ensure everyone has access to high-quality health care without breaking the bank,” said BCBSA President and CEO Kim Keck. “The rising prices of prescription drugs and medical care cause higher premiums and out-of-pocket costs. BCBSA has led efforts in the private market to make health care more affordable, but policy action is needed. We urge Congress to enact solutions that can cut costs by more than three-quarters of a trillion dollars by fostering competition, fixing drug pricing, and improving the care that patients receive.”

BCBSA’s Affordability Solutions for the Health of America are focused on:

  • Improving competition among health care providers by promoting reasonable reimbursement depending on the site of care, cracking down on anti-competitive behavior, and enacting policies that promote fair and transparent billing practices.
  • Increasing access to lower-cost prescription drugs by speeding generic and biosimilar alternatives to market, eliminating pricing tactics that slow production on generic drugs, closing patent and regulatory loopholes and giving consumers more information about pricing.
  • Ensuring patients receive the highest-quality health care by moving away from fee-for-service payment models so providers are rewarded and reimbursed for delivering safe, high-quality care, as well as modernizing the prior authorization process so that providers can make appropriate and cost-effective treatment decisions with their patients.

Over 10 years, these solutions would generate federal savings of $337 billion, would reduce private insurance premiums by $298 billion, and would save enrollees in Medicare and private plans a total of $206 billion in out-of-pocket costs.

Making health care more affordable for all Americans requires not only good public policy but private-market solutions as well. The Blues are leading by partnering with CivicaRx to bring lower-cost prescription medications directly to consumers, including producing insulin at a patient price of $30 or less per vial—a savings of nearly $400 for uninsured and underinsured patients.

Additionally, BCBSA and Blue Cross and Blue Shield companies joined together this month to launch Synergie Medication Collective, a first-of-its-kind approach that prioritizes partnership and transparency to improve affordability, accelerate innovation and increase efficiency in managing the costs of medical benefit drugs, such as chemotherapies to treat cancer or infusions to treat autoimmune diseases.

“We remain committed to working across industry and government to build a better, more affordable system of health,” continued Keck.

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.