Healthcare Affordability: Expanding Provider Roles to Improve Access and Reduce Costs

Economist Craig Garthwaite from Northwestern University's Kellogg School of Management has highlighted critical structural reforms to enhance affordability and access in the U.S. healthcare system. His recent study "Coverage Isn't Care" critiques the ongoing debate over the extension of Affordable Care Act (ACA) subsidies, emphasizing that changing subsidy levels affects payment distribution rather than total healthcare costs. Garthwaite argues that the focus should shift toward reducing overall healthcare spending while ensuring access to effective care. The study proposes easing restrictions on foreign-trained doctors, particularly those willing to serve Medicaid and low-income populations. This approach could increase the availability of medical professionals for underserved communities, potentially improving access and controlling costs without compromising care standards. Garthwaite notes that the difference in care levels between income groups largely reflects site differences rather than quality disparities. Additionally, expanding the scope of practice for nurse practitioners and physician assistants is recommended. These mid-level providers, with advanced training, can deliver effective primary care at a lower cost and offer more patient interaction time. Their increased independent practice, particularly in Medicaid-focused setups, aligns with value-based care models aimed at improving patient health outcomes while managing expenses. Existing frameworks such as state-specific residency or scope-of-practice laws could facilitate these reforms. State Medicaid agencies have the flexibility, via waivers, to implement innovative access programs. This state-level experimentation plays a critical role in identifying optimal solutions for low-income healthcare delivery, consistent with the concept of states as "laboratories of democracy." The analysis underscores that merely expanding insurance coverage is insufficient without addressing the provider supply side, which fundamentally drives access to care. Implementing reforms to increase provider availability and capacity can reduce healthcare costs and enable broader, more efficient care delivery. While legislative action at the federal level faces challenges, state-level initiatives represent a pragmatic path to reform the Medicaid system and improve access. The study stresses the importance of focusing on cost-efficient care provision to extend coverage benefits effectively. These recommendations aim to recalibrate healthcare policy discussions from payment debates to structural interventions that enhance the healthcare system's functionality for low-income and Medicaid populations. The potential reductions in total healthcare expenditure through improved provider supply may help stabilize or reduce premium costs by addressing root causes beyond insurance coverage mechanics. Overall, the research calls for a strategic shift in health policy to balance cost containment with real access improvements through workforce expansion and regulatory flexibility, benefiting providers, payers, and patients in the U.S. healthcare landscape.