ACA Blind Spot

Fuse Brown Addresses ACA ‘Blind Spot’ in Journal Article

Erin C. Fuse Brown, Georgia State University College of Law assistant professor of law, calls attention to the Patient Protection and Affordable Care Act’s (ACA) “blind spot” in her article, “The Blind Spot in the Patient Protection and Affordable Care Act’s Cost-Control Policies.”

Erin Fuse Brown

Though the ACA significantly trims Medicare prices and attacks overuse in Medicare and private settings, Erin C. Fuse Brown posits it lacks comprehensive polices to control private health care prices.

Published online ahead of print in the Sept. 22 issue of Annals of Internal Medicine, Fuse Brown’s article examines the ACA’s policies to control health care costs. Fuse Brown explains that there are two components to health care cost control: reducing overuse of health care and constraining rising prices.

“To bend the health care cost curve, we need to control private health care prices, particularly hospital prices. And to control prices, we need policies that address provider market power,” Fuse Brown said. She concludes that the ACA’s silence on price controls leaves states with the primary responsibility to pursue policies to control hospital prices and suggests states consider rate regulation where provider markets are so consolidated that they lack meaningful competition.

“The challenge is that the more politically popular approaches, like price transparency or even antitrust enforcement, won’t really work in places where the hospital market is already highly concentrated,” Fuse Brown said. “That leaves rate regulation, which is politically challenging, but there are a variety of ways to do it. Some are less prescriptive than others.”

Much of her recent scholarship focuses on policies affecting hospital prices for health care services, consumer financial protections in health care, and on the imperfections and loss of competition in the health care market. In August, the American Medical Association (AMA) Journal of Ethics published her article, “IRS Rules Will Not Stop Unfair Hospital Billing and Collection Practices.”

Through her work, Fuse Brown hopes to affect policy and help more people access and afford health care. She is researching the legal and regulatory options available to address the growing wave of vertical integration in health care.

“Integration is often touted for its potential to improve care coordination, quality, and efficiency, but it also has a tendency to push providers to consolidate into larger, more powerful health systems,” she said.

“Evidence shows these large conglomerates tend to use their market power to raise prices,” Fuse Brown said. “Vertical integration between hospitals and physicians or health systems and health insurance plans are difficult to regulate under current antitrust approaches, so we are examining a range of options for states and the federal government to gain the benefits of integrated health care while managing the downside risks to competition.”

“The larger take-away point is that we cannot hope to bend the health care cost curve without strategies to contain rising health care prices,” Fuse Brown said. “We cannot succeed if we focus only on reducing overutilization.”

A section of Fuse Brown’s article in Annals of Internal Medicine is available online.