It is likely that 2021 will be a dynamic year for US health care policy . There is pressing need and opportunity for health reform that helps achieve better access, affordability, and equity . In this commentary, which is part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2021 initiative, we draw on our collective backgrounds in health financing, delivery, and innovation to offer consensus-based policy recommendations focused on health costs and financing . We organize our recommendations around five policy priorities: expanding insurance coverage, accelerating the transition to value-based care, advancing home-based care, improving the affordability of drugs and other therapeutics, and developing a high-value workforce . Within each priority we provide recommendations for key elected officials and political appointees that could be used as starting points for evidence-based policy making that supports a more effective, efficient, and equitable health system in the US.