The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases

Abstract

Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs' efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legaltechnical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform.Keywords: health care, transparency, all-payer claims databases, federalism, United StatesThe United States spends more on health care, as both a percentage of GDP and on a per capita basis, than any other country. In 2009, the year before the adoption of the Patient Protection and Affordable Care Act (ACA), health care spending in the United States was nearly $8,000 per capita, about $3,000 more than its closest competitor, Norway (Squires 2012).1 While numerous factors have contributed to this increase-including rapid growth in utilization for popular and expensive diagnostic and therapeutic services-recent evidence has suggested that health care prices are a particularly important, and often overlooked, cause (Oberlander and White 2009;Laugesen and Glied 2011;Reinhardt 2012;Bai and Anderson 2015). In the private marketplace, responses to the problem of rising prices have been limited. As historical accounts suggest, policy innovations intended to more stringently standardize prices paid for health services have found greater traction within Medicare and Medicaid, while statelevel regulatory frameworks governing the commercial marketplace had weak institutional and political footing and were largely dismantled by the early 2000s (McDonough 1997a, b;Hackey 1998).While the existing literature helps to explain the failure of older regulatory frameworks, it cannot account for a significant shift in the ideas, interests, and institutions that dominate this policy arena (Sage 1999). In recent years, advocates of health care reform have embraced transparency instruments such as the Physician Compare NOT THE PUBLISHED VERSION; this is the author's final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page. Politics, Policy and Law, Vol 42, No. 1 (February 2017): pg. 5-52. DOI. This article is © Duke University Press and permission has been granted ...

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