Prior Authorization: Less Care, More Illness, Higher Profits

Aetna creates new obstacle to care for seniors, highlighting need for prior authorization reform, California Medical Association, August 10, 2021

One of the nation’s largest health insurance companies has created new bureaucratic hurdles for patients that could prevent many from receiving cataract surgery – part of a trend of insurance companies creating new “prior authorization” requirements that create hurdles for patients and physicians, reduce availability of health care services, and increase insurance company profits at the expense of patient care.

It has become common practice for health insurance companies to create new obstacles for patients, in hopes of not having to provide essential health care to those who need it. The reason for these types of obstacles is simple: Fewer surgeries performed translates to larger insurance company profits.

Like other insurance companies, Aetna has enjoyed record profits through the COVID-19 pandemic. The company, which was acquired by CVS Health in 2018, saw its operating income increase from $1.06 billion in 2019 to $3.07 billion in 2020.

Prior authorization requirements can be challenging for patients, creating  barriers to care and increasing administrative burdens for physicians who must spend time and resources to get approvals as insurance companies design and administer increasingly complex prior authorization systems.

The time delays and administrative burdens also continue to undermine health care outcomes. Most startlingly, in a 2020 American Medical Association survey, 30% of physicians reported that prior authorization led to a serious adverse event for a patient in their care such as hospitalization, medical intervention to prevent permanent impairment, or even disability or death.

Comment:

By Don McCanne, M.D.

Creating barriers to care in order to increase profits is a prime function of private insurers. To them, it is more important than taking measures to be sure that patients receive the care that they need. Prior authorization is a method designed to prevent patients from receiving the care that has been recommended.

How would a public insurance program, such as single payer Medicare for All, differ? Such programs are structured to enable everyone to obtain the care that they need, whereas insurer profits don’t even exist.

Why do our national policies continue to support private insurers through ACA insurance exchanges, Medicare Advantage plans, tax preferences for private employer-sponsored plans, and other government support of private insurance entities?

Health care justice for all is a primary goal of a universal public insurance program. That has to be preferred to the more expensive, inequitable, profit-driven system that we now have that leaves so many without the care they need while driving others into medical debt, not to mention the potential for disability or even death. Doesn’t our government care about us, the people?

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