Film, Panel Discussion Highlight Problems In Health Insurance Industry

HARTFORD, CT — A screening of a local film tackling the health insurance industry and panel discussion highlighted the persistent shortcomings of a system that often denies coverage with potentially deadly consequences.

The film, "Midas," by Hartford filmmaker TJ Noel-Sullivan, was screened at the Legislative Office Building. It follows a charismatic college dropout, played by Laquan Copeland, who recruits his best friends — played by Preet Kaur and Frederico Parra — to rob the health insurer that denied his mom's coverage.

The film received an overwhelmingly positive reaction from the audience before the film's creator, healthcare advocates, and elected officials participated in a panel discussion about the general state of healthcare in Connecticut.

Wendell Potter, a former vice president of communications for Cigna turned healthcare-reform advocate, shared his journey from "vice president of propaganda" in his own words to being an outspoken critic of the industry.

He said he began to question his participation in the insurance industry after visiting a free clinic in rural Virginia in 2007, where people lined up for hours to receive free medical care at a fairground. Potter resigned shortly after the death of Nataline Sarkisyan, who was initially denied coverage by Cigna for a liver transplant. He advised Cigna to cover the procedure due to intense media scrutiny, but Sarkisyan died a few hours after the insurer reversed its decision.

"People die every single day because of the actions of these [insurance] companies," Potter said. "And the reason they do this, folks, is to enhance shareholder value, to make Wall Street investors happy."

Potter pointed to the shift of several major insurers over the years toward pharmacy profits as an example. He said the insurance companies have purchased pharmacy benefit manager (PBM) companies to expand their revenues. According to Potter, Cigna, Aetna, CVS Health, and United Health Group control more than 80% of the pharmacies in the nation.

"They continue to deny coverage for medically necessary care," he said. "And there are many statistics that show when a denial is appealed, there's a great chance it will be overturned, which shows you medically necessary care is being denied by these companies."

Dr. Saud Anwar, a state senator from South Windsor and a practicing pulmonologist and intensivist, co-chairs the legislature's Public Health Committee and also serves as a vice co-chair of the Insurance and Real Estate Committee. He denounced the increasing use of Medicare Advantage, a privately-run version of traditional Medicare, saying the "malignant greed" of insurance companies are leading to negative impacts for patients.

"If you have Medicare Advantage, you are less likely to get intensive home care. If you have Medicare Advantage, you will have worse functional outcomes. This is from the Journal of American Medical Association," Anwar said. "62 studies were looked at, and patients were less likely to get post-acute care healthcare, and their care options were restricted if they had Medicare Advantage."

Anwar noted half the population on Medicare has been moved to Medicare Advantage, including state employee retirees who have no choice other than Medicare Advantage for their health insurance.

Connecticut's health care advocate, Kathleen Holt, also spent part of her career working at Cigna during its initial formation. After she left, she worked in hospitals where it was her job to negotiate insurance contracts.

In her experience, she said the insurance companies were only interested in the volume of patients her hospital could provide. Smaller, faith-based and mission-driven health organizations couldn't survive on insurance payouts, leading to a massive wave of consolidation in the healthcare industry.

"There's all kinds of gaming that's happening and it's really hard to know exactly who is watching the hen house, so to speak," she said. "Who is running healthcare? Who gets to decide who lives? It's not even organized chaos, right? It's fragmented dysfunction. As insurance companies buy providers, they buy home health agencies, they buy hospitals, the insurance company is becoming both the payer and the provider."

She said her office has helped over 4,000 residents this year, saving them more than $8 million. Most people aren't aware of the free services her office offers, and she said when her office intervenes, 80% of the time insurance pays out claims.

"Depending on the study, only three to 10% of people who are denied services actually appeal the claim," she said. "Most people walk away. They say, 'Oh, someone in authority said I don't deserve this test, I don't need this surgery.' And what ends up happening is that as people walk away, then the insurance companies are validated."

Insurers weren't included in Wednesday's discussion, but Susan Halpin, a spokesperson for the CT Association of Health Plans, sent a statement Thursday afternoon:

"Health plans play a vital role in sustaining access, quality, and affordability across Connecticut's healthcare system. Each year, insurers pay out billions of dollars in medical claims to doctors, hospitals, and pharmacies — ensuring that 80–85% of every premium dollar is committed to medical costs and quality improvement. Utilization review and prior authorization are important tools in that effort. They help ensure that care is safe, effective, and grounded in clinical evidence, while preventing unnecessary or duplicative services that drive up costs for everyone. Health plans are continually improving these processes — automating approvals, reducing paperwork, and working closely with providers to make the system faster and more transparent, to make sure every healthcare dollar delivers value and helps preserve affordable, sustainable coverage."