Families USA Comments on Senate Democrats’ RFI on Reforms to America’s Private Insurance System and Health Coverage that Works For All

Families USA provided comments on Ranking Member Ron Wyden and Senate Democrats' Request for Information (RFI) regarding the future of health coverage. We firmly support efforts to advance health and economic security and justice for all and relieve the daily harms of a broken health system by fixing the root causes of unaffordable, low-quality care, closing coverage gaps, strengthening premium subsidies, and redesigning how we pay for and deliver care.

Specifically, Families USA envisions a future health system built on a set of core guarantees for every consumer, no matter how they get their coverage:

1. The Affordability Guarantee: Families have their health care costs capped on a sliding income-based scale (premiums up to 8% of income across all payers including employer coverage), with real-time cost protection at the point of care, limits on co-insurance and deductibles, and a ban on predatory medical debt practices. People know in advance that they can get the care they need without undue financial burden.
2. The Access Guarantee: Every person has access to a standardized benefit package and an attributed primary care provider responsible for coordinating their care. Health plans must meet federal network adequacy benchmarks, national prior authorization standards with independent peer review, and mandatory reporting on denials and utilization.
3. The Consumer Protection and Experience Guarantee: Patients are protected against unfair bills and unsafe and predatory business practices, and they retain the ability to appeal bad decisions by plans or providers. Patients are empowered in their engagement with the health system and can reasonably expect timely customer service. Every patient owns their health data with real-time portable access. Nationwide interoperability standards eliminate fragmentation. Administrative processes, including prior authorization, eligibility, and enrollment are standardized in real time. AI and algorithmic tools in clinical and coverage decisions are disclosed, audited for equity, and subject to human clinical oversight.
4. The Accountability Guarantee: The system only profits when families are healthy. Payment shifts to population-based models and global budgets tied to outcomes, equity, and total cost of care. Hospital prices are capped, drug negotiation expands to the commercial market, and performance on health outcomes and disparity reduction is measured, reported, and enforced.