The assassination of UnitedHealthcare CEO Brian Thompson has intensified public scrutiny of health insurance companies, bringing national attention to their business practices.
Allegations of companies “delay, deny and defend” claims have reignited debates on the challenges patients and doctors face when navigating insurance systems.
Health insurers often operate within the frameworks set by employers or government entities that hire them to manage healthcare funds.
According to Forbes, insurers derive profits partly from what remains in the pool of premiums paid by employers, workers, taxpayers, and consumers. They are also compensated via administrative fees by self-insured employers and governments for managing these funds.
Decisions on coverage and costs are typically made in collaboration with employers or, in the case of state-funded Medicaid, lawmakers and governors.
Most US states have transitioned to privatised Medicaid programs managed by companies like UnitedHealthcare, Centene, and Blue Cross and Blue Shield. For Medicare, the federal government has similarly shifted toward private insurers via Medicare Advantage plans, Forbes reported.
Medicare Advantage, supported by both Democrats and Republicans, has become more popular than government-run Medicare, with over half of eligible Americans opting for these plans. However, industry rules requiring prior authorisations for treatments have faced criticism. The American Medical Association cited data from KFF, noting that 7.4 per cent of all prior authorisations were denied or partially denied in 2022—an increase from under 6 per cent annually between 2019 and 2021.
Private insurance under the Affordable Care Act (ACA) has also seen record enrollment due to enhanced subsidies under President Joe Biden’s administration. However, the uncertainty looming over these subsidies is set to expire in 2025, according to Forbes.
The Trump administration, if re-elected, could reduce industry regulations, potentially leading to coverage losses for millions.
The Commonwealth Fund warns that if subsidies expire, premiums could spike, causing coverage losses for approximately 4 million people.
The outlet further added that Trump’s previous efforts to repeal the ACA included proposals that could have resulted in over 50 million uninsured individuals and restrictions for those with preexisting conditions.
