The hottest Insurance Reform Substack posts right now

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"Under the law he had no remedy." How Dr. Dan Hurley's legacy could lead to health insurance prior authorization reform

HEALTH CARE un-covered • 519 implied HN points • 04 Oct 23
🏥 Health Politics Health Policy Insurance Reform Patient Advocacy Medical Ethics Healthcare system
  1. Dr. Dan Hurley fought against health insurance practices that often deny essential treatments, even after initial approval. His struggles highlight how complicated and frustrating dealing with insurers can be for patients.
  2. The law governing health insurance makes it hard for patients to challenge denied claims, leaving many without proper remedies for their disputes. This unfair system discourages people from appealing denied medical treatments.
  3. Hurley's legacy encourages the formation of advocacy groups to help patients fight against unfair insurance practices. His story inspires others to push for change in health coverage to ease the burden on families dealing with medical needs.

WSJ shows insurers make patients pay thousands for cheap generics while Brookings thinks Congressional PBM reforms could fall short

HEALTH CARE un-covered • 479 implied HN points • 15 Sep 23
🏥 Health Politics Healthcare access Insurance Reform Drug Pricing
  1. Health insurers are charging patients much more for generic drugs, even when those drugs are supposed to be cheap. This makes it hard for patients, especially those with serious health issues, to afford their medications.
  2. Researchers suggest that proposed Congressional reforms may not effectively lower drug costs because pharmacy benefit managers (PBMs) could find new ways to maintain their profits.
  3. The market for PBM services is very concentrated, giving a few companies a lot of power. More competition could help lower drug prices, but eliminating PBM profits might only reduce overall spending by a small amount.

Finally, Big Insurance's Pharmacy Benefit Managers are being probed by Congress

HEALTH CARE un-covered • 679 implied HN points • 15 May 23
🏥 Health Politics Health Policy Insurance Reform Pharmaceuticals
  1. Congress is looking into how Pharmacy Benefit Managers (PBMs) operate. They want to make sure these companies are not overcharging people for their medications.
  2. PBMs and insurance companies are causing more financial strain on patients by raising out-of-pocket costs. Many people are struggling to afford their medications because deductibles have doubled over the past decade.
  3. There are new bills being proposed to increase transparency and reform PBM practices. This could help ensure that savings from drug manufacturers are passed on to patients.

Insurers using AI and algorithms to deny claims; Sen. Elizabeth Warren calls on Biden to address Medicare Advantage profiteering

HEALTH CARE un-covered • 299 implied HN points • 04 Apr 23
🇺🇸 U.S. Politics Health Policy Insurance Reform Technology impact Government Action
  1. Insurance companies are using AI to deny a lot of claims quickly without human checks. This means many people might not get the coverage they need.
  2. Senator Elizabeth Warren is pushing for action against Medicare Advantage plans that are making huge profits while not providing necessary care. She's highlighting the need for better oversight.
  3. The healthcare system can be very confusing and stressful, especially for those who are sick. Navigating it feels even tougher when you’re not feeling well.

Rep. Katie Porter's Patients Before Profit Act is exciting.

HEALTH CARE un-covered • 139 implied HN points • 03 Mar 22
🏥 Health Politics Insurance Reform Public Health Legislation Patient rights Healthcare access
  1. The Patients Before Profits Act aims to protect patients by preventing insurance companies from cutting coverage during public health emergencies.
  2. This bill stops insurers from lowering payments to doctors and healthcare workers during crises like pandemics.
  3. It highlights how some insurance companies made huge profits while cutting reimbursements, hurting both doctors and patients.
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Find your Calling

Are You Okay? • 0 implied HN points • 13 Jun 20
🏥 Health & Wellness Medical education Insurance Reform
  1. Representation matters in medicine - textbooks need to reflect the diversity of patients to improve healthcare outcomes.
  2. Physicians should address and confront their biases to provide better care for all patients.
  3. Access to healthcare should be equal for everyone, regardless of race, job status, or socioeconomic status.