{"id":649468,"date":"2025-01-07T08:30:53","date_gmt":"2025-01-07T13:30:53","guid":{"rendered":""},"modified":"2025-08-11T16:07:55","modified_gmt":"2025-08-11T20:07:55","slug":"the-semi-sad-state-of-consumer-protection-in-health-care","status":"publish","type":"from-drew-altman","link":"https:\/\/www.kff.org\/from-drew-altman\/the-semi-sad-state-of-consumer-protection-in-health-care\/","title":{"rendered":"The Semi-Sad State of Consumer Protection In Health Care"},"content":{"rendered":"<div\n\tclass=\"wp-block-kff-shared-content--standard-layout wp-block-kff-shared-content\">\n\t\n\n<section class=\"wp-block-kff-shared-content-main\">\n\t\t\t<div class=\"post-header\">\n\t\t\t\t\t\n\t<h1 class=\"post-header__title\">The Semi-Sad State of Consumer Protection In Health Care<\/h1>\n\n\t\n\t\t\t<div class=\"post-header__meta\">\n\t\t\t\t\t<div>\n\t\t\t\t<span class=\"post-header__meta-label\">\n\t\t\t\tAuthor:\t\t\t\t<\/span>\n\t\t\t\t<a href=\"https:\/\/www.kff.org\/person\/drew-altman\/\">Drew Altman<\/a> \t\t\t<\/div>\n\t\t\t\t<div>\n\t\t\t<span class=\"post-header__meta-label\">Published:<\/span>\n\t\t\t<date>Jan 7, 2025<\/date>\n\t\t<\/div>\n\t\t<\/div>\n\t\n\t<div class=\"post-header__social-sharing\">\n\t\t<button class=\"post-header__social-sharing__button print\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M4.348 2.5v3.391H2.783A.787.787 0 0 0 2 6.674v4.696c0 .429.353.782.783.782h1.565V14.5h7.304v-2.348h1.565c.43 0 .783-.353.783-.782V6.674a.787.787 0 0 0-.783-.783h-1.565V2.5H4.348Zm.522.522h6.26v2.87H4.87v-2.87ZM2.783 6.413h1.782a.26.26 0 0 0 .085 0h6.697a.26.26 0 0 0 .086 0h1.784c.148 0 .261.114.261.26v4.697c0 .147-.113.26-.26.26h-1.566V9.283H4.348v2.347H2.783a.257.257 0 0 1-.261-.26V6.674c0-.147.113-.261.26-.261Zm9.39.783a.522.522 0 1 0 0 1.043.522.522 0 0 0 0-1.043ZM4.87 9.804h6.26v2.043a.264.264 0 0 0 0 .086v2.045H4.87v-2.043a.261.261 0 0 0 0-.085V9.804Zm1.043.783a.262.262 0 0 0-.265.26.26.26 0 0 0 .265.262h4.174a.26.26 0 1 0 0-.522H5.913Zm0 1.043a.26.26 0 1 0 0 .522h3.13a.26.26 0 1 0 0-.522h-3.13Zm0 1.044a.26.26 0 1 0 0 .522h4.174a.262.262 0 0 0 .264-.261.26.26 0 0 0-.264-.261H5.913Z\" fill=\"#004B88\" stroke=\"#004B88\" stroke-width=\".5\"\/>\n\t\t\t<\/svg>\n\n\t\t\tPrint\t\t<\/button>\n\t\t<a href=\"mailto:?subject=The%20Semi-Sad%20State%20of%20Consumer%20Protection%20In%20Health%20Care&#038;body=https%3A%2F%2Fwww.kff.org%2Ffrom-drew-altman%2Fthe-semi-sad-state-of-consumer-protection-in-health-care%2F\" class=\"post-header__social-sharing__button\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M2.333 4.25h-.25v9.14h12.5V4.25H2.333Zm1.083 1.693-.353-.2V5.23h10.54v.513l-.353.2L8.333 8.73 3.416 5.943Zm-.353 6.467V6.884l.107.06 5.04 2.857.123.07.123-.07 5.04-2.857.107-.06v5.526H3.063Z\" fill=\"#004B88\" stroke=\"#004B88\" stroke-width=\".5\"\/>\n\t\t\t<\/svg>\n\n\t\t\tEmail\t\t<\/a>\n\t\t<button class=\"post-header__social-sharing__button copy\">\n\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t<path d=\"M11.533 2.9c-.615 0-1.23.235-1.697.702L8.502 4.936a2.4 2.4 0 0 0-.575 2.46l.958-.958a1.32 1.32 0 0 1 .371-.748l1.334-1.333a1.331 1.331 0 0 1 1.886 0c.52.52.52 1.365 0 1.885l-1.334 1.333c-.21.21-.474.331-.748.372l-.958.958a2.393 2.393 0 0 0 2.46-.576l1.334-1.333a2.402 2.402 0 0 0 0-3.394 2.393 2.393 0 0 0-1.697-.702Zm-1.61 3.46a.533.533 0 0 0-.367.162l-3.2 3.2a.533.533 0 1 0 .754.754l3.2-3.2a.534.534 0 0 0-.387-.915ZM6.586 7.973a2.388 2.388 0 0 0-1.816.697l-1.334 1.333a2.403 2.403 0 0 0 0 3.394 2.393 2.393 0 0 0 1.697.702c.614 0 1.229-.234 1.697-.702l1.333-1.334a2.4 2.4 0 0 0 .576-2.46l-.959.958a1.32 1.32 0 0 1-.37.749l-1.334 1.333a1.334 1.334 0 0 1-1.886-1.885l1.334-1.334c.21-.21.474-.331.748-.372l.958-.957c-.21-.07-.426-.11-.644-.122Z\" fill=\"#004B88\"\/>\n\t\t\t<\/svg>\n\n\t\t\t<span>Copy Link<\/span>\n\t\t<\/button>\n\t\t\t<\/div>\n\t<\/div>\n\t\t\t\n\n<p class=\"wp-block-paragraph\">It\u2019s not likely that we are at a tipping point on consumer protection in health care, despite a hot news cycle just before the holidays, which rediscovered&nbsp;public angst about health insurance&nbsp;as&nbsp;expressed largely on social media following the murder of United Healthcare\u2019s Brian Thompson.&nbsp;The reality is that&nbsp;there is little prospect of significant consumer protection legislation in Congress with the Trump administration and Republicans opposed to regulation in charge. States have some ability to enact consumer protection regulations, but the issues they take on are narrow and differ state by state, and they cannot touch self-insured plans,&nbsp;which cover&nbsp;65%&nbsp;of workers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So far, no&nbsp;president, Secretary of&nbsp;Health and Human Services, or&nbsp;member of&nbsp;Congress has seen the opportunity for a larger package of consumer protection reforms that is big or bold enough to grab media attention or appeal to voters. Instead, we are likely to see a patchwork of pinprick actions at the federal and state level.&nbsp;Progress, but whack-a-mole.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The news media did not over-hype&nbsp;the&nbsp;underlying frustration with&nbsp;the complexity and cost of health care following the Thompson murder, but it did sometimes conflate&nbsp;an outburst on social media\u2014always&nbsp;from the most motivated or aggrieved\u2014with&nbsp;the potential for policy change.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As&nbsp;an organization that has focused on consumer issues since we started,&nbsp;including through&nbsp;a program dedicated to addressing&nbsp;<a href=\"https:\/\/modern.kff.org\/patient-and-consumer-protections\/\">patient and&nbsp;consumer&nbsp;protections<\/a>, wide-ranging polling on consumer issues, and regular reporting from our&nbsp;<a href=\"https:\/\/kffhealthnews.org\/news\/tag\/bill-of-the-month\/\">newsroom<\/a>, the moment feels a little like how we rediscover gun violence periodically, then&nbsp;<a href=\"https:\/\/kffhealthnews.org\/news\/article\/american-rage-health-care-reform-history-unitedhealthcare-ceo-killing\/\">move on<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nobody wakes up in the morning thinking warm and fuzzy thoughts about health insurance companies, and some people have had horrible experiences. The online reaction that followed&nbsp;Thompson\u2019s&nbsp;assassination&nbsp;may at times have been macabre, but it was also reflective of real problems people have&nbsp;experienced with&nbsp;their health coverage and&nbsp;conveyed&nbsp;the&nbsp;real anguish&nbsp;those&nbsp;who are sick and cannot get the care they need can experience. More than half of&nbsp;insured Americans&nbsp;(58%),&nbsp;and even more people who are in ill health (67%), report&nbsp;<a href=\"https:\/\/modern.kff.org\/private-insurance\/poll-finding\/kff-survey-of-consumer-experiences-with-health-insurance\">problems<\/a>&nbsp;with their coverage. This chart&nbsp;shows the&nbsp;problems people report from our big survey of consumer experiences. It\u2019s not one thing; it\u2019s \u201cdeath by a thousand cuts\u201d in a health system in which complexity is a feature,&nbsp;not a bug.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is not entirely new. The so-called managed care backlash of the mid 1990s was the last major consumer flashpoint in health care. It stopped the growth of&nbsp;health maintenance organizations (HMOs)&nbsp;and led to the expansion of&nbsp;preferred provider organizations (PPOs). Frustration with HMOs centered around narrow networks and gatekeepers restricting access to care. HMOs have their loyal followers,&nbsp;but many people wanted to be able to choose their doctors and hospitals. Narrow networks are still an issue, as are incomprehensible&nbsp;bills and Explanation of Benefits (EOBs)&nbsp;and more, but frustration with PPOs centers around utilization management:&nbsp;prior-authorization review and denials. There are&nbsp;<a href=\"https:\/\/modern.kff.org\/affordable-care-act\/issue-brief\/consumer-problems-with-prior-authorization-evidence-from-kff-survey\/\">only limited data<\/a>&nbsp;documenting it, but it feels like prior-authorization has become more restrictive and time-consuming for patients and physicians as insurers have hired outside organizations to take on the task, now with the&nbsp;<a href=\"https:\/\/www.statnews.com\/2024\/12\/23\/unitedhealth-group-stat-investigations-claims-denials-health-care-colossus\/\">assistance of AI<\/a>. &nbsp;We are certainly seeing it at KFF with our PPO plan and&nbsp;its&nbsp;utilization management contractor, where even an organization full of health policy experts with PhDs&nbsp;sometimes&nbsp;struggle&nbsp;to navigate the system and gain approvals, often assisted by our&nbsp;human resources&nbsp;department,&nbsp;which has better things to do.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Another issue&nbsp;raised&nbsp;following Thompson\u2019s murder&nbsp;has been&nbsp;the many ways in which utilization review meddles with the&nbsp;<a href=\"https:\/\/www.nytimes.com\/2024\/12\/08\/opinion\/health-care-anger.html\">doctor-patient<\/a>&nbsp;relationship,&nbsp;making&nbsp;their professional lives miserable and&nbsp;driving&nbsp;up their administrative costs. No question it does. And there is a serious question as to whether&nbsp;insurance companies should be the ones doing it, in a perfect world. They are anything but independent reviewers, with their own profits on the line. But our system is far from&nbsp;perfect&nbsp;and in&nbsp;our current&nbsp;health system&nbsp;there is no one else to do it&nbsp;(Mark Cuban has <a href=\"https:\/\/bsky.app\/profile\/mcuban.bsky.social\/post\/3lcxvn4jns223\">suggested<\/a> third-party administrators could take on the task for self-insured plans and under some circumstances now, consumers can bring appeals to independent reviewers picked by&nbsp;employers, but seldom appeal in the first place). &nbsp;Imagine what costs and premiums would be with no checks on a mostly for-profit health system with every doctor, responsible and irresponsible, ordering every test drug and procedure they&nbsp;want to,&nbsp;regardless of whether it\u2019s&nbsp;necessary or unnecessary?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Except, there actually is one world largely without utilization review: traditional Medicare.&nbsp;Instead, in one of health care\u2019s great tradeoffs, Medicare&nbsp;pays providers a lot less than private insurance does to control costs. There is an age-old debate about whether Medicare pays too little (obviously the provider view) or private insurance, fragmented and too weak to bargain in many markets, pays too much (the view long championed, for example, by the late, great health economist Uwe Reinhardt in his popular speeches).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Many years ago, I wrote an op-ed in&nbsp;The&nbsp;New York Times wondering if the health professions would accept a grand bargain: lower payments closer to Medicare levels, in return for getting their professional autonomy back. The bargain then involved eliminating an old program called the Professional Standards Review Organization (PSROs), which physicians didn\u2019t like. Today it might involve eliminating, or circumscribing, prior-authorization review in exchange for lower payments. I doubt health professionals, who fiercely resist payment cuts, would want the deal. Nobody likes tradeoffs.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Some things could be done&nbsp;to make things a little better for consumers, mostly&nbsp;through in-the-weeds changes: enforcing up-to-date directories of in-network physicians; making appeals processes more transparent and easier to use; establishing better criteria for using prior-authorization in the first place; so-called \u201cgold card\u201d programs for doctors who do not order unnecessary drugs or tests so they can bypass pre-authorization requirements for their patients; auto-renewal for authorization of ongoing care; independent review of denials for care for selected illnesses and chronic care; requirements that patients have a right to speak to a human (not&nbsp;a chatbot&nbsp;driven by AI); much better education and information for consumers who do not even know they can appeal denials; and more. &nbsp;There are also many consumer protections that have been legislated but not fully implemented. All of these \u201creforms\u201d are small and none of them work perfectly in practice.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One idea I haven\u2019t heard mentioned&nbsp;that has some merit&nbsp;is&nbsp;to require&nbsp;every insurer&nbsp;to&nbsp;have an internal ombudsman available to patients who advocates for them and reports to the CEO or the board,&nbsp;given that&nbsp;almost no consumers use current&nbsp;<a href=\"https:\/\/modern.kff.org\/private-insurance\/issue-brief\/claims-denials-and-appeals-in-aca-marketplace-p\">appeals<\/a>&nbsp;mechanisms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Several states&nbsp;passed targeted&nbsp;laws&nbsp;in 2024&nbsp;to address&nbsp;<a href=\"https:\/\/www.ama-assn.org\/practice-management\/prior-authorization\/10-states-have-tackled-prior-authorization-so-far-2024\">prior authorization<\/a>&nbsp;for the share of the market they can regulate. For example, Minnesota and Vermont exempted people with chronic conditions such as diabetes from prior authorization&nbsp;so&nbsp;long as their condition does not&nbsp;change. And Wyoming has a \u201cgold card\u201d program exempting physicians who are consistently approved by insurers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Very modest legislation drafted in Congress to codify Medicare Advantage regulations on prior authorization fell out of the Continuing Resolution to keep the government open&nbsp;pretty early on&nbsp;in that drama. That legislation shows how piecemeal \u201creforms\u201d can be in this area. It would have put into statute&nbsp;Biden administration regulations&nbsp;that shorten the timeframes for Medicare Advantage&nbsp;and other&nbsp;plans to make prior authorization decisions and facilitate the use of electronic exchange of information between insurers and providers for&nbsp;<a href=\"https:\/\/modern.kff.org\/private-insurance\/issue-brief\/final-prior-authorization-rules-look-to-streamline-the-process-but-issues-remain\/\">prior authorization<\/a>. &nbsp;Another example of the hyper-incremental approaches we should expect to see is a&nbsp;<a href=\"https:\/\/www.paloaltoonline.com\/news\/2024\/12\/16\/becker-bill-targets-use-of-ai-in-denying-health-claims\/\">new law<\/a>&nbsp;just passed in California sponsored by my local state senator Josh Becker. His bill, the Physicians Make Decisions Act, requires that any denial of care be reviewed by a physician, an attempt to rein in denials triggered by AI algorithms. That\u2019s a sensible and no doubt popular idea with unknown effects, since, of course, insurance company doctors deny care too.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One big thing that jumps out from the outrage and the&nbsp; opinion&nbsp;surveys is how skewed our priorities are in health care. I live in the Silicon Valley where daily I see the effort and money that goes into high-end innovation in health care and new digital technologies. But for average people it\u2019s the basics that are broken: they can\u2019t tell what their insurance covers and doesn\u2019t;&nbsp;decipher their bill; get an appointment with a primary care doctor,&nbsp;let alone a specialist; appeal a coverage decision they feel is wrong; or even talk to a human with more compassion and nuance than they can find on their health system\u2019s AI-assisted&nbsp; health system\u2019s&nbsp;app.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">We know costs are a problem, but for many people, it\u2019s the&nbsp;<a href=\"https:\/\/jamanetwork.com\/journals\/jama-health-forum\/fullarticle\/2811354\">complexity<\/a>&nbsp;of the system that is equally daunting.&nbsp;So far, neither the complexity of the system&nbsp;nor the need to do more to protect consumers in it has found a champion. It could be a lost opportunity.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\t<div class=\"post-footer\">\n\t<div class=\"post-footer__title\">More On<\/div>\n\t<div class=\"post-footer__links\">\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/topic\/health-costs\/\">\n\t\t\t\tHealth Costs\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/topic\/patient-consumer-protections\/\">\n\t\t\t\tPatient and Consumer Protections\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/topic\/private-insurance\/\">\n\t\t\t\tPrivate Insurance\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/administrative-costs\/\">\n\t\t\t\tAdministrative Costs\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/hospitals\/\">\n\t\t\t\tHospitals\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/managed-care\/\">\n\t\t\t\tManaged Care\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/physician\/\">\n\t\t\t\tPhysicians\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/politics\/\">\n\t\t\t\tPolitics\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.kff.org\/tag\/social-media\/\">\n\t\t\t\tSocial Media\t\t\t<\/a>\n\t\t\t<\/div>\n<\/div>\n\t<\/section>\n\n\n<section class=\"wp-block-kff-shared-content-sidebar\">\n\t\t\t\n\t\t\n<div class=\"wp-block-kff-shared-related-content--green wp-block-kff-shared-related-content\">\n\t<h2 class=\"wp-block-kff-shared-related-content__heading\">Also of Interest<\/h2>\n\t<div>\n\t\t\t<div class=\"wp-block-kff-shared-related-content__card\">\n\t\t\t<a href=\"https:\/\/www.kff.org\/affordable-care-act\/kff-survey-of-consumer-experiences-with-health-insurance\/\" class=\"wp-block-kff-shared-related-content__link\">\n\t\t\t\t<h3 class=\"wp-block-kff-shared-related-content__card-title\">\n\t\t\t\t\tKFF Survey of Consumer Experiences with Health Insurance\t\t\t\t<\/h3>\n\t\t\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"wp-block-kff-shared-related-content__card\">\n\t\t\t<a href=\"https:\/\/www.kff.org\/affordable-care-act\/consumer-problems-with-prior-authorization-evidence-from-kff-survey\/\" class=\"wp-block-kff-shared-related-content__link\">\n\t\t\t\t<h3 class=\"wp-block-kff-shared-related-content__card-title\">\n\t\t\t\t\tConsumer Problems with Prior Authorization: Evidence from KFF Survey\t\t\t\t<\/h3>\n\t\t\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"wp-block-kff-shared-related-content__card\">\n\t\t\t<a href=\"https:\/\/www.kff.org\/private-insurance\/claims-denials-and-appeals-in-aca-marketplace-plans\/\" class=\"wp-block-kff-shared-related-content__link\">\n\t\t\t\t<h3 class=\"wp-block-kff-shared-related-content__card-title\">\n\t\t\t\t\tClaims Denials and Appeals in ACA Marketplace Plans in 2021\t\t\t\t<\/h3>\n\t\t\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"wp-block-kff-shared-related-content__card\">\n\t\t\t<a href=\"https:\/\/www.kff.org\/private-insurance\/final-prior-authorization-rules-look-to-streamline-the-process-but-issues-remain\/\" class=\"wp-block-kff-shared-related-content__link\">\n\t\t\t\t<h3 class=\"wp-block-kff-shared-related-content__card-title\">\n\t\t\t\t\tFinal Prior Authorization Rules Look to Streamline the Process, but Issues Remain\t\t\t\t<\/h3>\n\t\t\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\t\t\t<\/section>\n\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>In this column, KFF President and CEO Drew Altman explores the state of consumer protections in health care and explains why, even with consumer frustration clear, Congress is unlikely to pursue major new health insurance protections but there could be some modest steps.<\/p>\n","protected":false},"author":48746306,"featured_media":649611,"template":"","meta":{"authors":[{"type":"foundation","id":49507,"name":""}],"exhibits":[],"jetpack_post_was_ever_published":false,"ep_exclude_from_search":false,"_classifai_error":"","_classifai_text_to_speech_error":"","search_keywords":"From Drew Altman, 10557, Drew Altman","shortlink":"","footnotes":""},"categories":[1274092,579145441,1286878],"tags":[903844,38746,527366,541893,398,579145421],"series":[579145466],"partner":[],"content-types":[579145480],"program":[],"class_list":["post-649468","from-drew-altman","type-from-drew-altman","status-publish","has-post-thumbnail","hentry","category-health-costs","category-patient-consumer-protections","category-private-insurance","tag-administrative-costs","tag-hospitals","tag-managed-care","tag-physician","tag-politics","tag-social-media","series-beyond-the-data","content-types-from-drew-altman"],"yoast_head":"<!-- This site is optimized with the Yoast SEO 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