AAmericans are sharing heartbreaking stories of insurance denials — which led to even worse illness and death — following the murder of Brian Thompson, CEO of mega-insurer United Healthcare.
An increase in practices such as prior authorizations and automated denials of coverage have made it more difficult for Americans to access health care, and changes are urgently needed to reform such practices and restore trust in the system health, experts said.
“Obviously, it is morally wrong to murder someone, and vigilante justice is not justice. But I’m not particularly surprised by the forceful expressions of anger at America’s health insurance system,” said Miranda Yaver, assistant professor of health policy and management at the University of Pittsburgh.
“When your life is turned upside down because you can’t get a test for something really bothersome, or you can’t get a medication that would actually solve your problems, it creates a lot of frustration, anger and loss of confidence . trust.”
The early December assassination “became a flashpoint for discussions about corporate power, bringing to the surface public frustration with the industry,” said Anthony Grasso, an assistant professor of political science at the Rutgers University Camden. “There’s very little accountability.”
When Dianna H’s daughter was born in December 2016, doctors detected heart and lung problems in the baby, who spent eight days in the neonatal intensive care unit.
Doctors wanted to give her vaccines to protect her against RSV (respiratory syncytial virus), an infection that can be fatal in children under two years old – even affected babies. no pre-existing conditions.
But her baby was not qualified because she was not born prematurely or under specific conditions, Dianna said.
Two weeks later, the newborn fell ill with RSV and suffered respiratory failure, Dianna said. She was taken by ambulance to an intensive care unit three hours away.
“We almost lost her a few times,” Dianna said.
Patients involved in insurance denials describe their frustration and impotent anger at feeling they have little recourse or means to hold companies accountable.
“I would be lying if I didn’t feel a little pleasure knowing that the insurance company had to pay hundreds of thousands of dollars because they chose not to spend a few thousand dollars on prevention,” Dianna said.
It’s a small consolation, she said, but it’s the closest thing to feeling that the insurer bears responsibility for a dangerous policy.
She closely followed the reaction to Thompson’s killing and said that while “it’s not something I would do,” she can “understand how someone would be pushed to do it.”
She also suffers from a spinal injury that, if she could have received preventative care, may not have required significant surgery. After seeing X-rays of a spinal fusion that Thompson murder suspect Luigi Mangione had posted online, Dianna said, “As soon as I saw that, I said, ‘I understand.’ Inadequate health care, pain, feelings of loss, disrespect and indifference are dehumanizing and as a result you do inhumane things.
Less than a third (31%) of Americans said they have a positive view of the healthcare system, compared to 51% who said the same in 2020, according to a Gallup study. survey released last week.
Cost and access to care are among the nation’s most pressing health issues, those surveyed said, with people citing these issues far more than health problems such as cancer or infectious diseases. About 79% of respondents said they were dissatisfied with the cost of care in the United States.
As healthcare spending has increased 67% over the past decade, profits at UnitedHealth Group, Elevance and Cigna have increased. pulled by 262% in the same time. These rates once came together until diverging significantly in 2016.
Health care coverage has reached its lowest approval level since Gallup began tracking the issue in 2001. The decline in satisfaction has been accompanied by an increase in coverage denials.
Humana, Cigna, and United Healthcare have all been hit with class action lawsuits over their use of new AI tools to process and deny claims.
One lawsuit claimed that 90 percent of United Healthcare’s initial AI denials were overturned on appeal, “an astonishing number,” Yaver said.
California recently passed legislation with bipartisan support to regulate automated tools like these, requiring medical oversight based on a patient’s records.
Nationally, legislation to expedite coverage decisions for seniors with Medicare passed the U.S. House of Representatives in September 2022 and was recently reintroduced in the U.S. Senate.
“Even if we don’t reduce the magnitude of denials, we can at least alleviate some of these delays,” Yaver said.
Without “a large-scale reinvention of the U.S. health care system, simply making it easier for people to navigate could help fix what’s broken,” she said.
Another area that could be reformed is the Employee Retirement Income Security Act (ERISA), which prevents workers in certain employer-sponsored plans from suing insurers for damages or even sometimes compensation fees. ‘lawyer. Yaver said this creates “liability issues because there’s no major penalty, there’s not really a cost for wrongful refusals.”
Even when insurers lose lawsuits over denial of care or face fines for violating regulations, any costs incurred can be passed on to customers by increasing the cost of premiums.
“A lot of the things we need to do to hold executives accountable are simply absorbed as the cost of doing business,” Grasso said, adding “it would be beneficial to further punish corporate executives and wrongdoing, damages and faults of companies.
There are also fundamental differences in how Americans understand and respond to harmful behavior, Grasso said.
“When someone is shot in the street, we define that as a crime — we have to punish that act of violence,” Grasso said. “But when we look at the harms caused by corporate decisions, like the denial of life-saving medical care, we generally don’t consider that violence. »
But this shooting and the outpouring of responses changes that understanding, he said.
“It’s violence,” Dianna said of insurers denying life-saving care. “It’s administrative violence.”
After her bout with RSV, Dianna’s daughter recovered and is now a happy and energetic eight-year-old. Yet those first days remain etched in her mother’s memory with every cough, every sneeze.
There is now a new, highly effective vaccine to protect against RSV, and it is recommended for all newborns, not just premature babies with certain health problems. And there are RSV vaccines for pregnant women and the elderly.
Dianna hopes they will make a difference – and that such drugs will not be subject to insurance denials.
“I hope no one ever has to go through what we went through again,” she said.