The fatal shooting of UnitedHealthcare CEO Brian Thompson has brought to the forefront the public's profound frustration with the health insurance sector. This incident has sparked a crucial conversation about the escalating costs and accessibility issues within healthcare. On "CBS Mornings" last Friday, Dr. Céline Gounder, a CBS News medical contributor and editor-at-large for public health at KFF Health News, emphasized that the primary concern is the exorbitant cost of healthcare. She pointed out that in this country, health-care-related expenses are the leading cause of bankruptcy after groceries, transportation, and rent. According to KFF polling, these costs are the number one concern for families. Gounder stated, "We've reached a point where healthcare is so inaccessible and unaffordable that people's frustrations are justified."

Can the Insurance Industry Address High Costs?

There are indeed measures that can be undertaken. Under President Barack Obama, the Affordable Care Act played a significant role in expanding health insurance coverage. As Gounder explained, "You had Medicaid, the marketplace, and subsidies to make purchasing plans on the marketplace more affordable. During the pandemic, these subsidies were made even more generous, and they were extended under the Inflation Reduction Act under President Biden." However, the challenge of rising healthcare costs remains. Gounder noted, "While efforts have been made to extend coverage and make healthcare more accessible, prices are continuously on the rise."

What Could Improve U.S. Healthcare?

In the United States, individuals are grappling with both rising healthcare costs and insurance premiums. According to a KFF poll from earlier this year, a quarter of U.S. adults have skipped or postponed getting the care they need due to cost. Gounder compared the U.S. approach with that of other developed countries, stating that the U.S. has a more fragmented and "piecemeal" system. She mentioned that many other countries have socialized medicine, like Medicare, which is the most expensive for the elderly in the world. Various proposals have been put forward to address the situation, such as the Inflation Reduction Act, which aims to negotiate down drug prices. Gounder added, "We've already seen one round of price negotiations. However, the incoming administration wants to eliminate many of the provisions of this act, and it remains uncertain whether these efforts will continue." Additionally, there have been mergers and acquisitions in the healthcare industry, leading to reduced competition. Gounder said, "The Biden administration has been actively pursuing antitrust suits to block some of these mergers. The Trump administration also tried to make healthcare pricing more transparent, but these efforts alone are not sufficient to solve the larger problem."

Steps if a Claim is Denied

On social media, doctors are sharing their experiences of an increasing number of claim denials, and Gounder has noticed this as well. She explained, "What we're seeing now is the insurance companies increasingly using AI to deny claims, and healthcare systems are developing competing AIs to fight against these health insurance AIs. As a doctor, I have to spend a lot of time on the phone with different companies to explain why my patient is in the hospital." If your claims are being denied, Gounder suggests the following steps. Firstly, collect all the paperwork you can to strengthen your case. Secondly, review the statements sent to you carefully to understand the issues. Thirdly, determine what your doctor can do to initiate an appeal. Finally, consider appealing to the state insurance commissions that regulate insurance. You can visit naic.com and look up your state.