Flags will be flown at half-staff outside United Healthcare's headquarters on December 4, 2024. … [+]
Attacks on UnitedHealthcare's business practices in the wake of CEO Brian Thompson's assassination have sparked a nationwide scandal over the health insurer's denial of care and delay in approving treatments. There is a lot of criticism.
Indeed, health insurance companies certainly do “Delay, deny, defend.” When patients and doctors submit claims for everything from surgeries and procedures to medications and hospitalizations.
However, health insurance companies are typically paid by consumers, taxpayers, workers, and employers who hire the insurance company to manage pooled funds, which are premiums paid by employers, or by governments that make payments to health insurance companies. following orders.
Doctors and hospitals submit claims after treating patients enrolled in these insurance plans. Insurance companies make profits based in part on the amount left unspent in the premium pool. And if an employer is self-insured, the health insurance company is also paid an administrative fee by the employer or government that buys its services to manage health care and manage employer and worker premium pools. Masu.
What is covered and how much you pay out of pocket or out of pocket is calculated by the insurance company that works with your employer's customers. These coverage decisions are not made solely by the insurance company. Alternatively, in the case of Medicaid coverage for the poor, what applies is determined by states and their legislators, and in some cases governors, who have influence over the coverage of each state's Medicaid program. Nearly every state in the U.S. is covered by UnitedHealth Group's UnitedHealthcare, Blue Cross Blue Shield Plans, Centene, Molina Healthcare, and many other insurers. Privatizing the Medicaid program.
And when it comes to Medicare coverage for seniors, the federal government offers UnitedHealthcare, Humana, CVS Health's Aetna and many Blue Cross and Blue Shield plans.
Medicare Advantage currently has a lower cost than government-run fee-for-service Medicare, even though insurance industry regulations include a requirement that patients obtain prior authorization before providing or paying for care. Very popular.
And while Republicans and Democrats have become bipartisan in their support for Medicare Advantage, the fantasy of single-payer, government-run Medicare becomes less likely with each passing Congress and presidential administration. More than half of all Americans eligible for Medicare choose a Medicare Advantage plan and the private insurance company that administers it.
The rule, supported by Republican and Democratic members of Congress and presidential administrations ranging from George W. Bush and Barack Obama to Donald Trump and Joe Biden, comes after efforts to tackle Medicare Advantage have been tightened in recent years. Despite this, we have supported its promotion.
“2022 data shows that 7.4% of all previous authorizations were denied or partially denied.” In response to the American Medical Association report, Citing KFF data. “This is an increase from the less than 6% of requests denied in each year from 2019 to 2021.”
Meanwhile, Biden also worked with Congress to strengthen subsidies for private individual insurance under the Affordable Care Act so that more Americans can enroll in individual Obamacare insurance under the Affordable Care Act. It has seen record subscriber numbers under the president.
But a second Trump administration and a Republican-controlled Congress that may not renew the enhanced subsidies when they expire at the end of 2025 are looming. Additionally, the Trump administration may loosen health insurance industry rules that mandated coverage under Obamacare plans. Certain essential health benefits.
“Pandemic-era increases in ACA marketplace subsidies are set to expire at the end of 2025, potentially resulting in higher premiums and the loss of coverage for an estimated 4 million people if Congress fails to extend the increased support.” A Commonwealth Fund report said in September:
“When Trump became president, he aimed to: Repeal and replace the Affordable Care Act Projections predict the number of uninsured will rise to more than 50 million people, with plans to reopen the door to pre-existing condition denials and exclusions for people who buy their own insurance. ” Added Commonwealth Fund report. “His government also Funds are almost zero For market outreach and enrollment assistance. The second Trump administration may restart efforts to add work requirements to Medicaid. led to loss of coverage”
