Helping States Address Rising Health Care Costs

Associate professor Erin C. Fuse Brown is helping states to develop policies to control health care costs driven by growing industry consolidation and rising prices. With the Affordable Care Act under attack nearly a decade after its passage, states have assumed a growing role in setting health policy and innovating new health reforms. Fuse Brown’s work has attracted the attention of leading health policy organizations, including the National Academy for State Health Policy, the Milbank Memorial Fund, the National Governor’s Association.

“It fuels my research to work on issues that are policy-relevant,” said Fuse Brown. “And to be policy-relevant, I benefit immensely from working with policymakers and regulators who are actually grappling with these issues. Right now, states are leading the way in terms of health policy innovation.”

Fuse Brown has consulted with NASHP to highlight an array of policy options to address consolidation-driven increases in health care prices, including a published white paper, “State Strategies to Address Rising Health Care Prices Caused by Health Care Consolidation.” At NASHP’s 2018 annual conference, she was a plenary panelist and helped lead a preconference workshop for state health policymakers on this topic.

Rampant health care consolidation has moved beyond traditional horizontal mergers to vertical or cross-market mergers that defy traditional antitrust analysis. Fuse Brown, with co-author, Jaime S. King, explored how antitrust analysis should adapt to these new forms of consolidation in “The Anti-Competitive Potential of Cross-Market Mergers in Health Care,” published in the St. Louis University Journal of Health Law and Policy. The American Antitrust Institute recognized it as the 2018 Best Antitrust and Mergers article.

States are exploring regulatory mechanisms to address health care consolidation, particularly in rural areas with acute health care needs. Fuse Brown wrote a commissioned report for the Milbank Memorial Fund on certificates of public advantage, a relatively untested strategy for states to oversee hospital consolidation in exchange for regulatory oversight against market power abuses. The report, “Hospital Mergers and Public Accountability: Tennessee and Virginia Employ a Certificate of Public Advantage,” explored how two states used the certificates to shield a large hospital merger from antitrust scrutiny in exchange for state oversight over the merging hospitals’ price increases and commitments to invest in population health and maintain access to rural health care services. The report serves as a case study for other states.

“I am concerned about the effects of rising health care costs on macro-level spending and on individual consumers,” said Fuse Brown. Her work on health care affordability and consumer financial protections caused state health policy organizations such as the National Governor’s Association and media outlets such as NPR to seek Fuse Brown’s expertise on surprise out-of-network medical billing and air ambulance expenses.

“Georgia State University provides a terrific platform to do cross-disciplinary research that combines legal, regulatory and policy analysis,” said Fuse Brown. “My work is improved by my collaborations within the Center for Law Health & Society and across campus with the Georgia Health Policy Center at the Andrew Young School of Policy Studies and the Institute for Health Administration at the J. Mack Robinson College of Business.” Given the plethora of health policy challenges facing the nation, Fuse Brown’s expertise will continue to be in high demand.