The following range of options would help redesign public and private healthcare programs to promote efficiency, stimulate price competition, and increase value for consumers:

• Continue to evolve Medicare and Medicaid payment policy away from fee-for-service and toward incentivizing providers to keep people healthy and out of expensive, intensive care settings like hospitals and nursing homes unless necessary.
• Bring transparency to healthcare prices, utilization and clinical data to unlock better policymaking and private market competition.
• Reduce administrative expenses by simplifying healthcare quality reporting and streamlining utilization management.
• Combine Medicare’s Part A hospital care program with Part B ambulatory services, implement an annual cost-sharing cap, a single deductible and simplified co-pay schedule.
• Change how Medicare and Medicare Advantage benefits (known as Part C) are structured to encourage greater head-to-head competition between Medicare Advantage plans and a modernized traditional Medicare program.
• Reform coverage for low-income individuals who need long-term and high-cost care and are eligible for Medicare and Medicaid (known as "dual eligibles").
• Evolve commercial insurance market rules to encourage the creation of novel benefit designs that fuel competition and empower patient consumerism.
• Modify FDA approval processes and patent laws to encourage greater generic drug and biosimilar competition.
• Encourage digital health innovation that spurs competition and reduces costs.

Policymakers also have a range of options to reduce spending via either reductions in payment, changes to eligibility, or advances in competition.

Options to consider include:

• Reduce federal payments to hospitals, post-acute care providers, doctors, and health plans.
• Expand Medicare’s negotiation authority for pharmaceuticals and extend to medical devices.
• Increase the Medicare eligibility age.
• Increase Medicare premiums or increase taxes on Medicare benefits on a means-adjusted basis, which would reduce the level of financial assistance provided to higher income beneficiaries.
• Convert Medicare into a premium support model, where the federal government provides an annual financial contribution to beneficiaries to buy a Medicare plan — either Medicare Advantage or traditional Medicare.
• Impose caps on spending for Medicaid, convert Medicaid into state block grants, or remove the 50% floor for federal matching dollars in Medicaid.
• Limit or reduce the ACA Marketplace subsidies for health insurance.

There are also many tax reform options that would raise new revenue to improve Medicare solvency as well as the sustainability of our overall healthcare system.

Options to consider include:

• Increase Medicare Hospital Insurance (HI) Part A payroll tax for all, or on a means-adjusted basis.
• Increase the Net Investment Income Tax (NIIT) and expand the NIIT to apply to additional types of income.
• Reform the Medicare Self-Employed Contributions Act (SECA) to apply to additional types of income.
• Reduce the value of the tax exclusion on employer-sponsored insurance.