Healthcare Reform: Prevention, Access, and Affordability

Executive takeaway: The system’s biggest gains come from shifting incentives away from fee-for-service and toward prevention, chronic disease management, and simpler administration—while keeping coverage expansions stable and affordable.

What’s driving costs

Aging demographics, high chronic disease burden (heart disease/hypertension), expensive technology, administrative inefficiency, and fee-for-service incentives that reward volume over outcomes.

Why prevention matters

Scalable screenings and early interventions (cancer and cardiovascular) reduce avoidable hospitalizations and downstream costs—improving quality of life and system sustainability.

System snapshot

U.S. healthcare spending is about $4.9 trillion, roughly 18% of GDP.
The uninsured rate fell from 14.4% to 7.7% after the ACA.
About 21 million people are enrolled in ACA Marketplaces.
The top 5% of spenders account for about 50% of total costs.
Approximately 41% of adults report difficulty paying medical bills.

Coverage & affordability levers

Medicaid expansion to reduce coverage gaps.
Marketplace subsidies to keep premiums and out-of-pocket costs manageable.
Medical debt relief initiatives to reduce household financial strain.

Prevention strategy focus

Expand access to cancer screenings and cardiovascular screening.
Strengthen primary care and chronic disease management pathways.
Align reimbursement with outcomes (value-based care) rather than visit volume.

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