The fatal shooting of Brian Thompson, CEO of UnitedHealthcare highlights the public’s deep frustration with the health insurance industry.
On “CBS Mornings” FridayDr. Celine Gounder, CBS News medical contributor and public health editor at KFF Health News, said the main problem is that health care costs are too high.
“What we’re seeing in this country is that the number one cause of bankruptcy is health care expenses,” she said.
After groceries, transportation and rent, health care costs are the cost of greatest concern for families in this country, according to KFF survey.
“We’ve gotten to a point where health care is so inaccessible and unaffordable that people are justified in their frustration,” 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 Actwhich helped to develop health insurance.
“You had Medical helpyou had the walkthen you also have subsidies to make it more affordable to buy 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 it remains unclear why health care costs are increasing.
“You’ve made efforts to expand coverage and allow more people to have access to health care, but prices are increasing,” Gounder said.
What might change in the U.S. healthcare system look like?
In the United States, people are facing rising health care costs and insurance premiums.
According to a KFF survey So far this year, a quarter of U.S. adults say they have skipped or postponed getting the care they need simply because of cost.
Compared to other developed countries, the United States 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 socialized medicine is the most expensive in the world in terms of health care for the elderly.”
Many different proposals have been made to improve the situation, she said, including Inflation Reduction Actwhich aims to negotiate downward the price of medicines.
“We have already seen a series of price negotiations. the new administration wants to eliminate the Inflation Reduction Act, or at least many of its provisions. So, we don’t know if this will continue,” she said.
There have also been mergers and acquisitions in the healthcare industry, which means less competition.
“The Biden administration has really tried to bring antitrust lawsuits to block some of these,” Gounder said. “The Trump administration, the previous administration, tried to make health care pricing more transparent. It was another way of trying to make things better. It’s not enough. All of this doesn’t do anything. than reduce a more serious problem.”
What can you do if a claim is denied
In their publications on social networks, doctors are increasingly sharing their experiences with claims denied – something Gounder sees too.
“What we’re also seeing now is an increasing use of AI by insurance companies to deny claims, and then competing AIs are being developed by health systems to combat insurance AIs illness,” she said. “As a doctor, I have to spend a lot of time on the phone with different companies trying to explain why my patient is in the hospital.”
If you find that your claims are being denied, Gounder suggests taking a few steps:
- Gather all possible documents to defend your case
- Look very carefully at the statements sent to you and what the problems are.
- See what your doctor can do to start appealing.
- Consider the state insurance commissions that regulate insurance that you may also appeal to. Go to naic.com and search for your state.