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Sick and Tired of Industry Greed, Activists Across US Target For-Profit Health Insurers
"I'm tired of insurance companies putting profit over people," said one activist at a Chicago rally.
Oct 12, 2023
Pushing back against insurers' annual denial of nearly a quarter-billion healthcare claims or pre-authorization requests, activists rallied in more than a dozen U.S. cities on Wednesday to demand "an end to private health insurance industry greed so people can get the care they need when they need it."
The Care Over Cost Campaign—a national grassroots initiative launched by the advocacy group People's Action—held rallies in cities including Baltimore, Maryland; Chicago, Illinois; Denver, Colorado; Detroit Michigan; Portland, Maine; and Hartford, Connecticut, known as the "insurance capital of the world." The campaign called on the industry lobby group America's Health Insurance Plans (AHIP) to "direct its members to put people over profit."
Activists implored AHIP and private health insurance corporations including Blue Cross Blue Shield (BCBS), UnitedHealthcare, Cigna, Humana, and Aetna "focus on ending the epidemic of care denials."
"CEOs at private health insurance companies profit off our pain and deny our healthcare. That's why people are rising up across the country to expose the lie that private health insurers are there for us when we need them," People's Action Healthcare for All campaign director Aija Nemer-Aanerud said in a statement.
"We all deserve the care we need when we need it, and it's time for greedy corporations like BCBS, Aetna, Cigna, and UnitedHealthcare to pay up and stop denying care," Nemer-Aanerud added.
According to Care Over Cost, private insurers deny more than 248 million claims and pre-authorization requests each year.
The campaign's demands include "sharing claims denial data, holding public meetings, ceasing lobbying, and working with policymakers and public authorities to transform the system to people over profit."
In Chicago, activists from groups including the People's Lobby, ONE Northside, and Jane Addams Senior Caucus held a "die-in" demonstration outside the downtown office of BlueCross BlueShield in support of what the organizers said are "the 700,000 Americans whose lives are impacted or lost due to lack of access to medical care from denied medical claims each day."
Activist Michael Grice, who lives with a disability, told rally attendees that "it took me over four years to get the wheelchair I'm sitting in now."
"I'm tired of insurance companies putting profit over people," Grice said. "They always do it for people with disabilities and senior citizens. I'm fed up with this garbage."
Illinois state Sen. Mike Simmons (D-7) addressed the Chicago rally, asserting that "it's not too much to ask in a developed democracy that people live long, healthy, prosperous lives."
"Those 700,00 denied claims—that's someone who needs insulin, someone who has an untreated liver condition," Simmons said. "That's somebody's aunt, somebody's mom."
Hartford rally attendee Kristen Whitney Daniels toldCT Insider: "This is an untenable situation. And it's only getting worse and worse every year, getting less and less covered."
"The frustrations are gonna boil over eventually," she added. "And [insurers] can either be part of the solution and working with patients to find ways to help patients have health, or they can be a part of the problem."
Responding to the protests, Alex Kepnes, executive director of communications for Aetna, toldCT Insider that the company wants to be "part of the solution."
"We believe that every American should have access to affordable, high-quality health coverage," Kepnes said. "The basic premise of making healthcare more affordable and simpler is at the core of CVS Health's transformation."
CVH Health, which owns Aetna, reported revenue of over $300 billion last year, with profits topping $4 billion—even as the company plans to lay off 500 Connecticut employees.
Daniels, who has Type 1 diabetes and other healthcare needs, said her insurance company, UnitedHealth, is part of the problem, making it extremely difficult to get the insulin she needs. She also said the company stopped covering one medication she needs a year after it was approved for coverage.
"I am tired of insurance companies getting rich off treating patients and disabled folks, like myself, as if we are expendable."
"The problem is this medication has worked so well for the last two years," Daniels said. "So I know how well it works. And then I want it and then I've been off of it for the last few months. And it's been horrible. It's like relearning to be diabetic again."
"I am tired of insurance companies getting rich off treating patients and disabled folks, like myself, as if we are expendable. I am not alone," she added. "That's why I am fighting and I will keep on fighting these claims and for affordable insurance that everyone has access to."
Phil Brewer, an emergency physician representing the single-payer healthcare advocacy group Physicians for a National Health Program (PNHP) at the Hartford rally, told CT Insider that "requiring pre-authorization used to be rare."
"Now it's routine," he added. "It also used to be that a human being actually reviewed the request, but now most requests are 'reviewed' by algorithm-driven AI programs."
At the Portland rally, Ronan Aubrey—whose family has a history of cancer—said they were surprised to receive a bill for a diagnostic ultrasound they thought would be covered by their insurance.
"Because my procedure was recommended by a doctor, I had assumed it would be fully covered. I was wrong," Aubrey told the Maine Beacon. "My insurer only covered a small part of the scan and procedure because I hadn't yet met my $3,500 deductible for the year."
"When an insurer tells us that medical care we need isn't covered, what are we going to do?" Aubrey asked. "My insurer shouldn't be deciding whether I should be getting a medical procedure—my doctor should."
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Inspector General, AMA and AHA Agree: Some Medicare Advantage Plans Are Endangering Their Enrollees' Lives
Americans should demand that the government stop rewarding Medicare Advantage plans for denying care inappropriately.
Jun 02, 2022
Medicare Advantage plans are endangering the lives of older adults and people with disabilities. The HHS Office of the Inspector General (OIG), which works to fight waste, fraud and abuse, recently issued a devastating report showing that these corporate health plans, which contract with the government to deliver Medicare benefits, are denying large amounts of care inappropriately.
Everyone enrolled in a Medicare Advantage plan should demand that the government prioritize the health and well-being of people with Medicare and let them know which plans are keeping people from getting needed care.
This is not the first time that the OIG has raised serious concerns about Medicare Advantage. But Medicare Advantage plans continue to engage in widespread wrongful denials of care with little accountability. What will it take for the administration and Congress to protect people with Medicare from these bad actors?
In a 2018 report, the OIG raised equally troubling concerns about the risks faced by older adults and people with disabilities in Medicare Advantage. The OIG recommended that the Centers for Medicare and Medicaid Services (CMS) act to protect people with Medicare and provide them "with clear, easily accessible information about serious [Medicare Advantage] violations." Unfortunately, these recommendations seem to have fallen on deaf ears.
Instead of calling out the bad Medicare Advantage actors and holding them to account, CMS is protecting corporate interests over the interests of older adults, people with disabilities, and their families. Protecting Wall Street over people with Medicare.
The OIG report explains that because CMS pays Medicare Advantage plans a flat fee regardless of the amount they spend on care, they have a "potential incentive...to deny beneficiary access to services and deny payments to providers in an attempt to increase profits."
Anyone enrolled in a Medicare Advantage plan offered by Humana, United HeathCare, Aetna, or another health insurance company should beware. These Medicare Advantage plans are requiring that our nation's most vulnerable individuals navigate an obstacle course when they need critical care. Worse still, they are inappropriately denying potentially life-saving care to tens of thousands of older adults and people with disabilities --care that traditional Medicare covers.
The OIG report finds that nearly one in seven Medicare Advantage plan denials of care are wrongful. It highlights inappropriate denials of costly tests, nursing home care, and rehabilitation services.
There's more. The Kaiser Family Foundation found that a sizeable number of Medicare Advantage plans don't include the best cancer specialists and cancer centers in their networks. We can only imagine the consequences for their enrollees with cancer and other costly health care needs.
The OIG report doesn't name names, even though some Medicare Advantage plans are clearly worse than others. For example, some plans are implementing prior authorization rules that are out of sync with standard medical practice.
The American Hospital Association confirms that "Inappropriate and excessive denials for prior authorization and coverage of medically necessary services is a pervasive problem among certain plans in the MA program." It urges CMS to hold Medicare Advantage plans accountable "for inappropriately and illegally restricting beneficiary access to medically necessary care."
An American Medical Association poll found that one in four physicians believe that prior authorization rules for some tests and treatments are harming patients. But, there's no way for people with Medicare to find out whether their Medicare Advantage plans are coming between doctors and patients to their detriment.
The OIG report neither outs the bad Medicare Advantage plans nor highlights the good ones. And, CMS keeps paying the bad ones, leaving their enrollees in a dangerous situation. An NBER report found that Medicare would save "around ten thousand" lives a year if CMS canceled contracts with the bottom-ranking five percent of Medicare Advantage plans and randomly reassigned their enrollees to other Medicare Advantage plans.
Instead of meaningfully penalizing or cancelling contracts with Medicare Advantage plans for establishing procedures that withhold necessary care from people with Medicare, CMS is giving them an 8.5 percent rate increase next year. It's continuing to pay them significantly more per enrollee than it spends on people in traditional Medicare. As a result, the corporations that administer Medicare Advantage plans are profiting wildly!
CMS leads our nation's parents and grandparents to believe that they can pick a Medicare Advantage plan that's right for them -- and then allows them to pick one that could gravely harm them or cause their premature death.
Curiously, most members of Congress laud Medicare Advantage plans--notwithstanding the OIG report and a sea of other reports raising concerns about them. But, some members of Congress are speaking out about the serious risks Medicare Advantage plans present for older people and people with disabilities and the huge costs they impose on taxpayers and the Medicare Trust Fund.
Last month, Congresswomen Katie Porter, Rosa DeLauro, and Jan Schakowsky, along with Senator Elizabeth Warren, led a letter to CMS. Joined by 15 other members of Congress, they called on CMS to protect people with Medicare and highlighted some of their concerns with Medicare Advantage. Senator Sherrod Brown led a similar letter three years ago, and CMS did nothing.
Americans should demand that the government stop rewarding Medicare Advantage plans for denying care inappropriately. In the meantime, everyone enrolled in a Medicare Advantage plan should demand that the government prioritize the health and well-being of people with Medicare and let them know which plans are keeping people from getting needed care.
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