A tidal wave of recent stories and revelations have spotlighted one of the most serious problems in American healthcare: Some of the nation’s largest corporate health insurance companies use self-interested tactics that delay and deny patient care to drive up their own profits.
As the evidence mounts that patients, providers, and taxpayers are being taken advantage of by certain corporate insurers, some corporate insurers and other well-funded special interests are trying to distract and deflect blame for their role in the rising cost of healthcare by attacking the heart of patient care.
This coordinated anti-hospital campaign threatens to hurt patients even further by reducing access to the 24/7 care that Americans count on.
The shocking ways insurers put profits ahead of patients
An avalanche of recent reporting and investigations have detailed the shocking ways that some of America’s largest corporate insurers drive up their own profits at the expense of patients, providers, and taxpayers.
Explosive new reporting by the New York Times confirms what 9 out of 10 physicians already reported: Insurers’ profit-seeking policies and bureaucratic red tape — such as requirements for prior authorization — hurt patients’ health and medical outcomes.
- “Dr. Singh spent two hours coordinating and submitting an appeal for a patient with spinal cord damage and brain trauma. After 19 days at Good Shepherd, ‘she’s come a long way, but she can’t be home alone safely,’ he said. Yet her insurer was ‘telling us to push her out now.’ He decided instead to extend her stay while the prior authorization appeals proceed. ‘Unfortunately, we will have to absorb the costs’ — about $1,800 a day, he said.”
- “In 2022, a second inspector general’s report revealed that 13 percent of denied prior authorization requests met Medicare coverage rules and probably would have been approved by traditional Medicare. By that point, a KFF analysis found, the proportion of prior authorization denials overturned on appeal had reached 82 percent, raising the possibility that many ‘should not have been denied in the first place.’”
- “After breaking a hip last fall, Ms. Nathanson now lives at Episcopal Homes. She, too, resents having her insurer overrule her health care professionals. ‘I wish I could have stayed with them longer,’ she said in an email. ‘But I had to go home before I was ready.’”
An investigative report by the Wall Street Journal revealed that certain corporate insurers drained $50 billion from Medicare for dubious diagnoses and diseases that physicians never treated.
- “Private insurers involved in the government’s Medicare Advantage program made hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded payments from 2018 to 2021 including outright wrong ones…”
- “The questionable diagnoses included some for potentially deadly illnesses, such as AIDS, for which patients received no subsequent care, and for conditions people couldn’t possibly have, the analysis showed. Often, neither the patients nor their doctors had any idea.”
- “Some diagnoses claimed by insurers were demonstrably false, the Journal found, because the conditions already had been cured. More than 66,000 Medicare Advantage patients were diagnosed with diabetic cataracts even though they already had gotten cataract surgery…”
- “Insurer-driven diagnoses by UnitedHealth for diseases that no doctor treated generated $8.7 billion in 2021 payments to the company, the Journal’s analysis showed. UnitedHealth’s net income that year was about $17 billion.”
New research shows that Medicare patients enrolled in corporate insurers’ Medicare Advantage plans are more likely to face delays and costs they can’t afford.
- “Larger shares of beneficiaries in MA plans than in traditional Medicare reported they experienced delays in getting care because of the need to obtain prior approval… and couldn’t afford care because of copayments or deductibles (12% vs. 7%).”
When a February cyberattack on a UnitedHealth subsidiary left patients and providers in the lurch, the ultra-profitable insurer moved too slowly and did too little to help those affected.
- Representative Frank Pallone (D-NJ): “It’s wrong that healthcare providers, pharmacies and patients continue to bear the brunt of a failure by a corporation that earned $371 billion to either prevent or quickly remedy this situation.”
- Senator John Barrasso (R-WY): “50% of rural hospitals are already operating right now in the red. This breach may send some of them into a financial spiral for which they can’t come back.”
- Senator Marsha Blackburn (R-TN): “It’s widely acknowledged that Optum’s temporary assistance program fails to adequately address the financial setbacks that are caused by this… providers have resorted to tapping into personal savings, retirement funds, seeking loans from banks.”
- Senator Elizabeth Warren (D-MA): “Because UnitedHealth has bought up every link in the healthcare chain, you are now in a position to jack up prices, squeeze competitors, hide revenues, and pressure doctors to put profits ahead of patients.”
To distract from their actions, certain corporate insurers are funding a campaign to attack hospitals
While giant corporate insurers hurt patients, they are partnering with billionaire donors and other special interests to fund a coordinated political campaign to change the subject — by attacking the hospitals that Americans count on. Their goal is clear; pay less for seniors’ care and increase their own bottom line.
- Politico Pro: “The Effort to Keep ‘Site Neutral’ Alive”
- “Insurers, unable to push through a top legislative priority in the latest spending bill, are already working on plan B — a lobbying blitz targeting lawmakers at home and in Washington.”
- Chief Healthcare Executive: “The Alliance for Site Neutral Payment Reform, which includes America’s Health Insurance Plans [and] Blue Cross Blue Shield Association… is calling on lawmakers to reduce Medicare payments to outpatient departments.”
“Site neutral” Medicare cuts would slash resources from patient care, especially in rural and underserved communities
Already, chronic underpayments and rising costs have many local hospitals that patients rely on struggling just to stay afloat.
- Already, nationwide, a majority of hospitals operate in the red.
- Already, in rural America alone, 149 hospitals have been forced to close their doors or convert into less capable facilities since 2010.
- And 30% of our remaining rural hospitals are at serious risk.
- Already, at current funding levels, Medicare only repays hospitals 82 cents for every dollar hospitals spend caring for Medicare patients.
- Already, corporate insurers’ excessive claim delays and denials are eroding hospitals’ financial stability.
Policymakers must not allow corporate insurers to hurt patients and providers even more
The massive additional cuts to care that insurers, billionaires, and special interests are pushing would put Americans’ healthcare access at even greater risk.
“Site neutral” cuts and other anti-patient, anti-hospital policies would threaten the fabric of 24/7 high-quality healthcare that every American counts on.
Policymakers should reject the coordinated, billionaire-backed, corporate insurer-funded campaign to cut patient care, advance solutions that support and strengthen access to care, and hold accountable the corporate insurers that line their own pockets by hurting patients and providers.