Five health insurance executives appeared before congressional committees on Thursday and faced a barrage of angry questions from Republicans and Democrats, who found bipartisan agreement that their constituents were being crushed by rising U.S. health care costs.
Members of the committee grilled the executives over a number of industry issues: the companies’ billion-dollar profits, the compensation packages for executives, their concentration of market power, as well as their practice of denying care and medications for patients.
Again and again, the executives were reminded that their companies had repeatedly denied care to patients. The representatives came armed with an array of specific cases — a mom with breast cancer; a 3-year-old with a tumor; and a patient who had a stroke.
The executives deflected much of the blame for rising health coverage costs, saying that they were striving to contain prices and that the premiums reflect not their own greed, but the rising prices for hospitals and drugs.
The rising premiums are “more an effect than a cause,” said Stephen Hemsley, the chief executive of UnitedHealth Group, the nation’s largest health insurer.
Of the five executives on the panel, Helmsley faced many of the most angry questions.
Rep. Nanette Barragán (D-California) began by bringing up the case of a 3-year-old with a tumor in her bladder whose treatment, she said, had been denied by UnitedHealthcare, a case that led the family to declare bankruptcy. She then pivoted from the family’s loss to the chief executive’s personal finances.
“Mr., Hemsley, you got a $60 million, one-time equity award … that’s a lot of money,” she said, and then opined on his responses. “Mr. Hemsley, the way you are talking about this is not sympathetic. It’s not compassionate. … These are people’s lives.”
The pressing cost of health care has become a potent political issue this year.
The end of the extended Affordable Care Act subsidies, beginning in January, led to rapid increases on the cost of health care coverage for millions of people. But millions more — and the majority of Americans under 65 — who receive their health care through their employer are also facing higher costs. Over the past five years, the price of health coverage for an employee’s family has risen 26 percent, to $27,000 annually, according to a KFF survey. The burden of paying for that policy is shared — the employer picks up 75 percent of the cost on average, or about $20,000, and the employee pays 25 percent, or about $7,000.
The burden on employees doesn’t stop with the premium, however. The employees pay out-of-pocket to reach deductible limits, which have been rising as well.
Insurers, however, are only one part of the sprawling U.S. health care industry. Over five years, the health expenditures in the United States for hospitals, professional services and prescription drugs have each risen nearly 40 percent or more.
Paul Markovich, chief executive of Ascendiun, the parent company of a nonprofit insurer, told the House Energy Committee that because the various interests involved in health care — insurers, hospitals, doctors, drug companies — often only blame one another, the required reform may depend on congressional action.
“I’ve come to the conclusion that the system will not fix itself,” he said. “The health care system needs some tough love and clear direction. The American government is in the best position to provide both.”
But aside from the animus toward insurers, the hearing also made clear that Democrats and Republicans appear far from agreement on government solutions that might address the issue of rising costs.
Republicans blamed the ACA, which they often referred to as the “Unaffordable Care Act,” for rising costs. Democrats blamed Republicans for voting to end the extended ACA subsidies for millions of people.
Whoever is to blame, insurers are the intermediary between health care providers and the patients they serve, leaving them between rising prices and patients.
At the hearing, the American anger over denied claims and pre-authorizations was manifest. Some of the angriest questions came from Rep. Buddy Carter (R-Georgia), a former pharmacist, who spoke of having to deny medications to patients because insurers did not cover the payment.
“Let me ask you Mr. Hemsley — yes or no — have you ever personally looked a patient in the eye and explained why your company denied them a medication their doctor said was needed?” Carter began.
“Um,” Hemsley hesitated.
Carter: “Have you ever personally looked a patient in the eye and told them that?”
“I have looked patients in the eyes many times. I don’t recall whether it was regarding a prior authorization,” Hemsley responded.
Carter summed up with his own indignation, his voice rising: “Well, Mr. Helmsley, let me tell you. I practiced pharmacy for 40 years. I’m the one who had to look the patient in the eye. I’m the one who had to tell them that — on your behalf. It’s not fun.”
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