The fatal shooting of UnitedHealthcare CEO Brian Thompson is surfacing the public’s deep frustration with the health insurance industry.
On “CBS Mornings” Friday, Dr. Céline Gounder, CBS News medical contributor and editor-at-large for public health at KFF Health News said the main issue is that health care costs are too high.
What we see in this country is that the number one cause of bankruptcy is health-care-related expenses,” she said.
After groceries, transportation and rent, health care costs are the No. 1 cost of concern to families in this country, according to KFF polling.
“We’ve gotten to a point where health care is so inaccessible and unaffordable, people are justified in their frustrations,” Gounder said.
Can the insurance industry do something about high costs?
There are things that can be done, Gounder said.
Under President Barack Obama, for example, there was the Affordable Care Act, which helped to expand health insurance.
“You had Medicaid, you had the marketplace, then you also have subsidies to make it more affordable to purchase plans on the marketplace,” Gounder said. “Those were made even more generous during the pandemic, and then those more generous subsidies were extended under the Inflation Reduction Act under President Biden.”
But, there is still the challenge of why health care costs are rising.
“You have efforts to extend coverage and make more people have health care be available, but prices are going up,” Gounder said.
What could change in U.S. health care look like?
In the U.S., people are faced with both rising health care costs and insurance premiums.
According to a KFF poll from earlier this year, a quarter of U.S. adults say they’ve skipped or postponed getting the care they need simply because of the cost.
Compared with other developed countries, the U.S has a different, “very piecemeal” approach, Gounder said.
“Many other countries have what we call socialized medicine,” Gounder said. “By the way, Medicare is socialized medicine, and even that socialized medicine is the most expensive in terms of health care for the elderly in the world.”
Many different proposals have been made to improve the situation, she said, including the Inflation Reduction Act, which aims to negotiate down the price of drugs.
“We’ve already seen one round of price negotiations. The incoming administration wants to eliminate the Inflation Reduction Act, at least many of the provisions of that. So whether that will continue, we don’t know,” she said.
There have also been mergers and acquisitions in the healthcare industry, which means less competition.
“Biden administration has really been trying to pursue antitrust suits to block some of these,” Gounder said. “The Trump administration, the prior administration, tried to make health care pricing more transparent. That was another way of trying to make things better. It’s not enough. These are all sort of chipping away at a bigger problem.”
What you can do if a claim is denied
In posts to social media, doctors are sharing their experiences with more and more claims being denied — something Gounder is seeing too.
“What we’re also seeing now is increasing use of AI by the insurance companies to deny claims, and then you have competing AIs being developed by healthcare systems to fight the health insurance AIs,” she said. “Me as a doctor, I have to spend a lot of time on the phone with various different companies to try to explain why my patient is in the hospital.”
If you are finding your claims to be denied, Gounder suggests following a few steps:
- Collect all of the paperwork you can to make your case
- Review very carefully the statements that are sent to you and what the issues are
- See what your doctor can do to start in terms of filing an appeal
- Consider state insurance commissions that regulate insurance that you can also appeal to. Go to naic.com and look up your state.
