WORKING TO ENSURE COMMERCIAL HEALTH INSURERS DO THEIR PART TO SUPPORT PATIENT CARE

The following information was released by the American Hospital Association (AHA):

by

Rick Pollack, President and CEO, AHA

Every year tens of millions of Americans dig deep into their pocketbooks to pay for health insurance plans that will cover both preventive and necessary care for individuals and families.

The premiums are paid in good faith, as consumers count on insurers when the time comes to uphold their end of the agreement and cover the procedures, operations and medications prescribed by qualified medical professionals.

Unfortunately, the bargain is often one-sided, with some commercial insurers happy to rake in premiums but then delay or deny care and claims or bury individuals under mountains of red tape, relying on obstructive administrative tools such as unnecessary prior authorization to avoid paying legitimate claims just when people most need assistance with their medical bills.

The practices that restrict or deny access to necessary care for millions of patients while also driving up costs are a national problem. A CBS News story this week, "State of denial: How insurance companies impact health care today," highlights how millions of Americans are struggling with medical care unable to pay high premiums, burdened with high deductibles and denied coverage for necessary tests and treatment by some commercial health insurance companies. The piece includes interviews with doctors and health experts about how medical care is being eroded by insurers motivated by profit, with one doctor saying insurance companies have "made it more difficult to be healthy in the United States."

Some top health insurance executives are slated to testify on Capitol Hill next week as part of a broader effort to examine health care costs. For years, the AHA has highlighted the negative impact excessive and unnecessary commercial insurer administrative red tape and paperwork including prior authorization, delays and denials have had on care for patients. The practices of some commercial insurers have added to the cost of health care, making it harder for patients to access and afford care, as well as exacerbated strain on clinicians that contributes to caregiver burnout as they strive to get needed care for patients authorized.

Increased scrutiny and reforms of some of these harmful practices are paramount as some commercial health insurers continue to increase their size, scope and power. For example, late last year, the American Medical Association released its annual reporton health insurance competition in 2024, finding that in 91% of metropolitan statistical area markets, at least one insurer had a commercial market share of 30% or greater.

The AHA continues to advocate with Congress, the administration, regulatory agencies and insurers directly for needed reforms to the burdensome policies and practices that add tremendous cost to the health care system, vacuuming up staff time with paperwork and reducing bedside time spent on personal patient interaction.

For example, we have provided recommendations to the Department of Health and Human Services and the Centers for Medicare and Medicaid Services to help ensure that commercial insurance plans are easing the burden of the complex and time-consuming prior authorization process on patients and providers. In addition, we continue to urge Congress to pass theImproving Seniors' Timely Access to Care Act of 2025 (H.R. 3514/S. 1816), which would streamline the prior authorization process in the Medicare Advantage program by eliminating complexity and promoting uniformity to reduce the wide variation in prior authorization methods that frustrate both patients and providers.

We also have engaged directly with Anthem and Aetna, pushing back on new policies that would restrict patients' access to care. And we continue to spotlight for policymakers and the public the negative effects these oppressive policies have on patient access to care.

The AHA will continue to engage on every front to protect patients' health and ensure that medical professionals, not the insurance industry, are making the key decisions in patient care. We will continue to work with Congress, the federal agencies, commercial health insurers and all stakeholders to improve the delivery of patient care, reduce costs and decrease regulatory burdens as we work together to advance health in America.