The COVID-19 pandemic put our health care system through a stress test that it barely survived. Doctors, nurses and health care workers put their lives on the line to treat millions of Americans battling a highly contagious and deadly disease.
Those same front line workers are increasingly burned out because of the burdens they had to bear during the pandemic. Rural hospitals continue to close at alarming rates, forcing rural Americans to travel further and further to receive health care.
It’s a challenging time for the American health care system — unless you’re one of America’s largest private health insurers.
In 2022, UnitedHealth Group made over $20 billion in profit. Cigna made $6.7 billion, Elevance Health made $6 billion and CVS Health made $4.2 billion. All told, America’s largest health insurers raked in more than $41 billion of profits in 2022.
That is a staggering sum of money. It is so much money, in fact, that you might assume that Americans are able to receive high quality, accessible care whenever they need it. Sadly, that is not the case.
First of all, nearly 28 million Americans are still without any health insurance at all. That number is down thanks to the Affordable Care Act, but even with the progress made, roughly 10% of non-elderly Americans are still unable to afford health insurance.
Even if you can afford health insurance, that is not a guarantee of affordable, accessible health care. Health insurers make money by not paying for health care. Their bottom line depends on refusing to pay for care and they are ruthless when it comes to protecting their profits.
Anthem Blue Cross Blue Shield has been consistently underpaying reimbursements and inappropriately denying coverages. In 2021, 53% of Anthem’s medical bills for the second quarter were unpaid, amounting to $2.5 billion.
Another way health insurers try to get out of paying for care that patients need is by requiring pre-authorization for routine and even lifesaving care. UnitedHealth announced earlier this year that it was going to require prior authorization for colonoscopies, a critical way for doctors to detect colorectal cancer.
An American Medical Association survey found 94% of physicians surveyed said that prior authorizations lead to delays in receiving care and 80% said that prior authorizations can lead to treatment abandonment. UnitedHealth was forced to alter its policy due to public outrage, but they are still requiring “advance notification” for the procedure, which doctors fear could lead to bureaucratic delays and delayed care.
If insurance companies are not held accountable for their greed, our health care system outcomes will get worse. Across the country, patients can’t afford care and hospitals can’t afford to keep the lights on and their doors open, while insurers rake in hundreds of billions of dollars. We need more regulation of health insurers to ensure that they are not putting profits before people.
One reform Congress should revisit is the Medical Loss Ration (MLR) loophole. The Affordable Care Act introduced a cap on insurance profit margins, but not profit levels. Insurers are supposed to spend 80% of every dollar on care and only 20% on administrative costs. However, instead of lowering premiums, the insurance companies have been incentivized to increase costs so that they can make more money.
Congress should step in and address this problem in order to lower the cost of health care and curb insurance industry abuses. We need Congress because we know that, left to their own devices, the big insurers have proven they will put profits ahead of people every single time. Every quarterly earnings report makes that abundantly clear.
This commentary first appeared in Arizona Mirror, which is part of States Newsroom, a nonprofit network of news bureaus supported by grants and a coalition of donors and includes Pennsylvania Capital-Star.
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