Unraveling the Complexities of UnitedHealthcare's Business Practices
Health Insurance Denials and Delays
After the assassination, it became evident that health insurance companies like UnitedHealthcare are indeed engaged in the practice of "delay, deny and defend" when it comes to patient claims. From surgeries and procedures to drugs and hospitalizations, these denials and delays have raised concerns. Doctors and hospitals submit claims after treating patients who are subscribers to these insurance plans. Insurers make money based on the unspent portion of premium pools. In the case of self-insured employers, insurers also receive administrative fees. The coverage decisions are a collaborative effort between the insurance company and the employer client. In Medicaid for the poor, state lawmakers and governors hold sway over coverage decisions. Almost all states have privatized Medicaid programs with insurers like UnitedHealthcare playing a significant role.Even in Medicare coverage for seniors, the federal government is increasingly relying on privatized insurers through Medicare Advantage plans. Despite insurance industry rules requiring prior authorization, Medicare Advantage has become more popular than government-run fee-for-service Medicare. Both Republicans and Democrats support Medicare Advantage, making single-payer government-run Medicare less likely.
Data from 2022 shows that 7.4% of prior authorizations were denied or partially denied, up from less than 6% in previous years. Meanwhile, under the Affordable Care Act, private individual coverage has seen record enrollment under the Biden White House, with enhanced subsidies helping more Americans afford coverage. However, the looming second Trump administration and a Republican-controlled Congress may not renew these subsidies and could ease industry rules, potentially causing premium spikes and coverage losses for millions.
The Role of Insurance Rules and Politics
Congressional rules endorsed by both Republican and Democratic administrations have supported the march towards Medicare Advantage. But in recent years, it has come under more scrutiny. Rules like prior authorization requirements have been in place, but their enforcement and impact vary.During the Trump administration, there were efforts to repeal and replace the Affordable Care Act, which could have led to a significant increase in the uninsured and the reintroduction of preexisting condition denials. His administration also cut funding for outreach and enrollment assistance. A second Trump administration might restart efforts to add work requirements to Medicaid, which could result in coverage losses.
The interplay between insurance rules and political decisions is complex. It affects not only the insurance industry but also the lives of millions of Americans who rely on these plans for their healthcare.