| We don’t know if President Donald Trump made good on plans to meet with major health insurers yet, but their CEOs are slated to testify today before two congressional committees about why so many people can't afford healthcare in the
US. |
| Insurers have been a source of public ire long before UnitedHealthcare’s CEO was killed a little more than a year ago, unearthing a torrent of new frustration about how expensive and difficult to use health coverage often is. And just a few days ago, Trump released his healthcare plan, and though vague, it does pitch ways of lowering premiums and "holding big insurance companies accountable." |
| But insurers, according to their prepared testimonies for today's hearings, are planning to stick with an old playbook: blame hospitals and drugmakers. It's a message insurers have used time and again. (Drugmakers have for years trotted out their own version, too, blaming insurers and hospitals.) |
| "The cost of health insurance is driven by the cost of health care. It is a symptom, not a cause," UnitedHealth Group CEO Stephen Hemsley said in his testimony. |
| He’s not wrong. Insurers set premiums to cover the cost of health services and drugs. Americans are demanding more and more care, and the prices for that care are increasing, according to recent CMS data. The insurance CEOs parrot these causes in their remarks before counting the ways they try to tame costs (shifting to value-based care) and improve patients' experience (simplifying prior authorizations). |
| The insurers' solutions share some common ideas. They want Congress to reform the No Surprises Act process by which insurers and providers settle disputes over out-of-network bills, arguing that providers are gaming the system to inflate payouts. They want lawmakers to fix loopholes that allow pharma companies to thwart competition (and for Congress to ban direct-to-consumer ads). And they pushed for more value-based care, more telehealth, expanded HSAs, and allowing high deductible health plans to cover more services at no
cost. |
| Paul Markovich, CEO of Blue Shield of California's parent company Ascendiun, went further, advocating for PBM reform and spending targets for the entire healthcare system. |
| What’s missing from most of the testimonies — and I know this won’t shock you — is an acknowledgement of insurers’ own role in America’s broken healthcare system. Prices might drive healthcare costs, but there are certainly incentives for the companies to permit, even welcome, higher spending. There are seemingly
countless examples of insurers driving up Medicare Advantage costs through their coding shenanigans. They emphasize that their insurance profits are capped by the ACA, but fail to mention that their businesses expand far beyond insurance to less regulated industries — and are also owners of healthcare providers themselves. |
| Will pressure from lawmakers and Trump make any difference? |
| - Shelby |
