Conclusion

It requires significant stakeholder engagement to develop buy-in, a robust infrastructure operated with dedicated staff or contract resources for data collection and analysis to measure performance and identify cost growth drivers, and willingness to carry out enforcement measures as needed and take strong steps necessary to bend the cost growth curve.

As states move their programs from infancy to maturity and begin to take more concrete steps to develop programs and policies that address rising health care costs and make health care more affordable and accessible, they must navigate and balance the interests of multiple powerful stakeholders, including insurers, the pharmaceutical industry, healthcare providers, and patients. High levels of cost growth have plagued the US health care system for decades, and the strong institutional forces that oppose efforts to meaningfully constrain cost growth are at play. 

In the two years since this playbook’s first publication, states have seen more efforts to dismantle or weaken their target programs–from the repeal of executive orders that established the programs to challenges to the validity of data, and proposed legislation to strip down accountability and enforcement mechanisms. To some degree, these efforts are a testament to the attention that these target programs are drawing to the nation’s healthcare affordability problem. They also highlight the significant challenges associated with slowing health care cost growth. 

States need to be strategic in fighting to protect the foundation they have laid while simultaneously making improvements, drawing on strong leadership, compelling data, and effective communications and stakeholder engagement to actively address challenges and adapt to changing economic and political landscapes.