Healthcare affordability push puts agent pay in jeopardy, AHIP says

Agents and brokers have a role to play in the health care system but they may be impacted by the push for affordability that has seen carriers cutting or eliminating commissions.

That was the word from Jeanette Thornton, AHIP executive vice president of policy and strategy, during a news conference held as part of the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum in Washington.

“Agents and brokers play an important part in assisting consumers with purchasing coverage,” she said. “The decision to purchase insurance is a tough choice and we appreciate and recognize the role of agents and brokers.

“But we also are focused on affordability, and the push and pull with agents and brokers is part of that.”

In June 2025, AHIP, along with 50 major insurers, signed an industry pledge regarding prior authorization, announced alongside the leadership of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services.

The six AHIP‑led commitments include:

1. Standardizing electronic prior authorization with a target of Jan. 1, 2027
2. Reducing the scope of services subject to prior authorization.
3. Honoring existing authorizations for 90 days when patients change plans
4. Improving transparency and communication around prior authorization decisions
5. Expanding real‑time approvals for at least 80% of prior authorization requests by 2027
6. Ensuring medical review of all clinical denials

Thornton said AHIP will provide its first update on the progress made on these commitments.

“We want to make prior authorization a much more frictionless process,” she said. “We want to move toward a system where you can get an authorization in real time.”

Affordability has been a buzzword throughout the AHIP conference. AHIP president and CEO Mike Tuffin said, “We share the frustration about the cost of care. It is not sustainable. We keep reminding policyholders that we are the only part of the system committed to holding down costs. We are the only part of the system held accountable for our rates, and we welcome the conversation around affordability.”

Tuffin noted that when consumers decide to purchase health insurance, their first consideration is whether their provider is part of the insurer’s network. The second decision is about affordability.

He also called on drug manufacturers to tackle the affordability issue. Congress recently enacted major pharmacy benefit manager reform as part of the Consolidated Appropriations Act of 2026, which became law Feb. 3.

“Now that Congress tackled PBM reform, it’s incumbent on drug manufacturers to respond by lowering their prices,” he said.

Tuffin also said it’s important to look at the direct-to-consumer market for prescription drugs.

“We are the only country except New Zealand where consumers get wall-to-wall advertising intended to induce demand for prescription drugs,” he said. “Drug manufacturers are single-handedly keeping TV stations afloat. I think this advertising needs to be looked at.”

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].