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Health Insurers Pledge to Reform Major Process That Stood in Way of Patient Care

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Roughly three-quarters of the nation’s health insurance providers signed a series of commitments this week in an effort to improve patient care by reducing bureaucratic hurdles caused by insurance companies’ prior-authorization requirements.

Director of the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz, alongside Health and Human Services Secretary, Robert F. Kennedy Jr., announced the new voluntary pledge from a cadre of insurance providers, who cover roughly 75% of the population, during a press conference Monday. The new commitments are aimed at speeding up and reducing prior-authorization processes used by insurers, a process that has been long-maligned for unnecessarily delaying patient care and other bureaucratic hurdles negatively impacting patients.

“The pledge is not a mandate. It’s not a bill, a rule. This is not legislated. This is a opportunity for industry to show itself,” Oz said Monday. “But by the fact that three-quarters of the patients in the country are already covered by participants in this pledge, it’s a good start and the response has been overwhelming.”

Prior-authorization is a process that requires providers to obtain approval from a patient’s insurance provider before that provider can offer certain treatments or services. Essentially, the process seeks to ensure patients are getting the right solution for a particular problem.

However, according to Oz, the process has led to doctors being forced to spend enormous amounts of man-power to satisfy prior-authorization requirements from insurers. He noted during Monday’s press conference that, on average, physicians have to spend 12 hours a week dealing with these requirements, which they see about 40 of per week. (Read more from “Health Insurers Pledge to Reform Major Process That Stood in Way of Patient Care” HERE)

Young Adults Believe Health Insurance Companies, Suspected Killer Share Equal Blame In Healthcare CEO’s Murder: Poll

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Most young adults believe discontent with the nation’s health insurance system and the killer of UnitedHealthcare CEO, Brian Thompson, share equal responsibility in the executive’s murder, according to a new poll.

Nearly 70% of U.S. adults between the ages of 18 and 29 said “a great deal” or “moderate amount” of responsibility for the Thompson’s murder can be attributed to “denials for health care coverage by health insurance companies,” “profits made by health insurance companies” and “the individual who committed the killing,” according to a survey from NORC at the University of Chicago conducted between Dec. 12-16 with 1,001 adults participating.

(Read more from “Young Adults Believe Health Insurance Companies, Suspected Killer Share Equal Blame In Healthcare CEO’s Murder: Poll” HERE)

Discrimination: Health Insurance Company Asks Managers Not To Hire White Men

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Cigna — one of the country’s largest heath insurance providers — has reportedly encouraged hiring managers to avoid hiring white males at the company.

According to a Friday report from the Washington Examiner, employees at the company have been “asked not to consider white men in hiring decisions.”

Citing leaked training documents and chat logs, the outlet noted that Cigna employees are also expected to undergo “racist and discriminatory” sensitivity training on topics such as “white privilege,” “gender privilege,” and “religious privilege.”

“Chat logs between an employee and a hiring manager viewed by the Washington Examiner detail an incident where a minority candidate with strong credentials performed exceptionally well in an interview,” the outlet noted. “When that employee suggested to the hiring manager that the company wave the candidate through to the next step in the process, the hiring manager dismissed the candidate under the assumption he was white.” . . .

One employee told the outlet, “Given the hiring practices they have in place where white, male candidates are blocked, regardless of qualifications, I have to say, ‘Yes, there’s obvious discrimination at this company.'” (Read more from “Discrimination: Health Insurance Company Asks Managers Not To Hire White Men” HERE)

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43 Million Americans in Danger of Losing Health Insurance as a Result of Coronavirus Crisis, Study Shows

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As many as 43 million Americans are in danger of losing their current health insurance as unemployment surges amid the novel coronavirus pandemic, a new study has shown.

The Urban Institute’s Health Policy Center, an economic and social policy think tank, published a study last week on how the economic recession caused by COVID-19 could affect the health insurance coverage of Americans. The analysis found that between 25 million and 43 million Americans are at risk of losing, or have already lost, their health insurance, which is often tied directly to an individual’s employer.

“Thirty million workers filed initial unemployment claims between March 15 and April 25. Near-term forecasts suggest the unemployment rate will likely be between 15 to 20 percent by June,” the research, which was supported by the Robert Wood Johnson Foundation, explained.

Although the analysis noted that some Americans would be able to apply for Medicaid in states that have expanded the Affordable Care Act (ACA), known commonly as Obamacare, while others would purchase other private insurance, it estimated that many would be unable to access coverage. The study went on to project how high the number of uninsured Americans will rise. (Read more from “43 Million Americans in Danger of Losing Health Insurance as a Result of Coronavirus Crisis, Study Shows” HERE)

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House Republicans Release a Health Care Plan That Aims to Finally End Our Insurance Nightmare

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Earlier this year, President Donald Trump vowed that “the Republican party will soon be known as the party of health care.” Republican lawmakers have now put forward a lengthy plan in an effort to realize that prediction.

On Tuesday, the Republican Study Committee released “A Framework for Personalized Healthcare,” an Obamacare replacement plan with the goal of driving down costs and improving access to care in a way that prioritizes individual choice over top-down government regulation.

“If government-run health care were the answer, the Veteran’s Health Administration (VHA) would serve as the gold standard,” the summary says. “Of course, it does not. … Does anyone really believe Washington bureaucrats could be trusted to manage the individual care of hundreds of millions of Americans?”

So what would the overall plan do? In order to understand that, it’s probably best to start with a brief refresher on the overall structure of Obamacare.

The four key parts of Obamacare — as explained previous CR article — are:

Regulations: These mandate that companies expand coverage to more people and benefits, therefore sending the cost of insurance skyrocketing.

Subsidies: Because the insurance is now unaffordable as a result of regulation, anyone below a certain income level is subsidized to purchase medical insurance.

Medicaid expansion: In addition to subsidizing non-Medicaid patients to purchase unaffordable medical insurance (thanks to the regs), Obamacare dramatically expanded both the eligibility and the federal subsidy rate to the states for Medicaid in order to cover more people.

Tax increases: Tax hikes were meant to fund the venture, and the individual mandate penalty was meant to keep young and healthy people from gaming the system by only paying for insurance if and when they needed it.

So what does the new RSC plan do differently?

First it seeks to remove the regulations that made health insurance so expensive in the first place, while allowing states to implement them within their own borders. However, regulations that force companies to issue insurance and not exclude high-cost-and-risk factors from coverage “would be retailored” under the plan.

Instead of Obama’s regulatory-subsidy combination, the RSC plan would seek to address costs for more expensive patients through state-run “guaranteed coverage pools,” under which “health care costs would be subsidized with federal grants and further contained by any state-enacted premium-setting restrictions.”

Insurance portability is “the cornerstone” of the proposed framework’s goal of “neutralizing the issue of pre-existing conditions,” according to the document. In this case, portability means people’s ability to take their insurance with them if they change jobs or states.

“Enhancing portability is critical for purposes of preventing breaks in coverage, during which time an individual could develop a medical condition posing an impediment to obtaining health insurance,” the plan reads. “In this way, continuous coverage can be a de facto safeguard against pre-existing conditions, so long as the operative legal backdrop ensures that coverage protections are portable.”

The framework would also seek to create equity in the taxation difference between paying for private plans and those offered by employers.

“A person choosing to purchase health insurance with income from their paycheck is at a significant tax disadvantage versus a person receiving employer-sponsored insurance. When an employer spends money to purchase a plan for an
employee, the employer does not have to pay payroll taxes on the benefit nor does the employee pay payroll or other federal and state income taxes on the benefit. On the other hand, if an employee seeks to purchase individual coverage, the funds they would use to do so are subject to each of those forms of taxation.”

One way to address this disparity, the RSC says, is by allowing people to pay for private insurance premiums out of tax-free Health Savings Accounts (HSAs) as opposed to their taxed income.

The plan would also expand HSAs, so that they could be also used for other services and products that currently have to be purchased with after-tax income; these include market-disrupting health care approaches like direct primary care, telemedicine, and health-sharing ministries.

Chip Roy, a freshman House conservative and cancer survivor who has been working for months to forge a new conservative narrative on health care policy — hailed the release of the plan at a Tuesday press conference.

Roy said that, in addition to addressing costs, access, and portability concerns, the framework would also “end the pre-existing [condition] problem before it starts; you shouldn’t be trying to solve this on the back end.”

“We should make it to where people have care because they’re able to pay for it and go into the market and and buy it just like you do any other service — food, shelter, clothing,” Roy added. “Nowhere else do we regulate it to death so you can’t get access to it.” (For more from the author of “House Republicans Release a Health Care Plan That Aims to Finally End Our Insurance Nightmare” please click HERE)

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