News from Congressional Hearings on Healthcare Affordability: Insurance Execs Grilled on Prior Auth

Last week, the Energy and Commerce (E&C) Health Subcommittee and the Ways and Means (W&M) Committee held hearings on healthcare affordability. Both congressional committees called in the CEOs of the 5 largest health insurance companies: Ascendiun, CVS Health, Elevance, The Cigna Group, and UnitedHealth Group. The E&C and W&M committees have jurisdiction over Medicare. The hearings were the first in what is expected to become a series examining healthcare costs.

Throughout the hearings, Democrats blamed Republicans for higher premiums caused by the expiration of the Affordable Care Act (ACA) enhanced premium tax credits while Republicans focused on underlying flaws of current law, saying the ACA has allowed insurance companies to game the system to secure higher profits without lowering healthcare premiums.

Rep. Greg Murphy, MD (R-NC), W&M Committee member and co-chair of the GOP Doctors Caucus, accused the insurance executives of “putting profits over patients” and weaponizing prior authorization, resulting in “killing people” who are trying to get healthcare.

Highlighting insurance company ownership of pharmacy benefit managers (PBMs) and physician practices, Rep. Murphy and other Republicans said the insurance companies are destroying competition in the healthcare system. “The market is dominated by a handful of insurers, and they may control several facets of the supply chain, including PBMs,” said E&C Health Subcommittee Chair Morgan Griffith (R-VA).

Rep. Kim Schrier, MD (D-WA), centered her comments on prior authorization that leads to denied or delayed care. She described the United Healthcare Group as the “poster child” for Medicare Advantage (MA) abuse.

The insurance executives downplayed their use of prior authorization and defended vertical integration as a way to deliver better coordinated care.

ASNC-Endorsed Legislation

Rep. Mike Kelly (R-PA), sponsor of the Improving Seniors’ Timely Access to Care Act (H.R. 3514 | S. 1816), called on the companies to support the bill, which would reform MA prior authorization processes. The legislation would require MA plans to establish electronic prior authorization using standardized transactions and clinical attachments as well as develop a process for real-time decisions on routinely approved items and services.

ASNC endorsed the Improving Seniors’ Timely Access to Care Act and is asking members to urge their congressional representatives to cosponsor the legislation. The easiest way to contact Congress is through the ASNC Action Center.

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