Coverage That Doesn’t Add Up

Today, millions of Americans pay for their health insurance, but when it comes time to use their coverage, they realize their insurance plan covers less and less.

Hospitals care for everyone who comes through their doors and see firsthand how low-quality insurance plans limit patients’ access to care, making the affordability crisis worse.

Despite paying monthly premiums, many families still face uncertainty about whether their insurance will be there when they need it most. Too often, Americans must also pay thousands of dollars out of pocket to meet high deductibles before comprehensive coverage begins, leading some to delay or forgo needed care due to out-of-pocket costs.

On top of that, insurance companies use narrow networks, prior authorization requirements, and delays or denials that drive up costs and make it harder for patients to access care.

As policymakers consider solutions to the affordability crisis, it is clear that the current system is not working for millions of Americans. That is why FAH is calling on policymakers to address the real drivers of health care costs—insurers shifting the financial burden to patients and hospitals—and to ensure that coverage provides meaningful access to care when families need it most.

“Hospitals witness the affordability crisis playing out every day – out-of-pocket costs continue to rise and families worry their coverage won’t be there when they need it. It’s time to fix what’s not working… that means addressing benefit designs that leave patients exposed to high out-of-pocket costs  and bringing real accountability and transparency to how vertically integrated insurers are using premium dollars.”

Charlene MacDonald, FAH President and CEO, Statement ahead of House Energy and Commerce Health Subcommittee’s hearing on lowering health care costs

Key Facts

“To lower the cost of health care for Americans starts with demanding transparency from big insurers… Our hospitals serve every patient who walks through their doors and have made significant investments to provide their patients with upfront tools that empower them to make the best choices for their health needs. Hospitals are doing their part for patients – now it’s time for insurers to do the same.”

Charlene MacDonald, FAH President and CEO, Statement after the State of the Union Address

What Congress is Saying

“Complicated benefit designs, narrow networks, prior authorization requirements and opaque coverage decisions often leave patients feeling like they are paying more for less. The market also lacks transparency,” Energy and Commerce Committee Chair Brett Guthrie (R-Ky.)

“Even when people do have coverage, good care can still be a fight to get through denials, prior authorization requirements, and sky-high co-pays and deductibles that create additional barriers between America’s patients and the care that they need,” Representative Diana DeGette (D-Colo.)

Consumers rightly expect that the premiums they pay will translate into meaningful access to hospitals, physicians and other needed services. To ensure this happens requires appropriate oversight of insurer plan design, network adequacy and the use of premium revenue.

FAH offers the following recommendations to strengthen consumer affordability, promote insurer accountability, and ensure that Marketplace overage translates into meaningful access to care:

• Ensure efforts to improve premium affordability do not come at the expense of meaningful coverage or access to needed care.

• Improve oversight of brokers and agents to ensure compensation structures align with consumer interests and do not incentivize fraudulent or inappropriate Marketplace enrollments.

• Strengthen medical loss ratio oversight to ensure that premium dollars are directed toward patient care rather than financial agreements with vertically integrated insurer structures.

Read FAH’s Letter to Lawmakers Here