by Jake Johnson
A pair of new stories examining the increasingly common but shadowy U.S. insurance industry practice of refusing to pay for certain treatments drew outrage Wednesday from patient advocates and Medicare for All proponents, who said the reporting further reveals the harms of for-profit healthcare.
The investigative outlet ProPublica focused its attention on the “galling” secrecy around insurance companies’ claim denials, which frequently leave patients with massive medical bills and little clarity as to why their claims were rejected.
“How often insurance companies say no is a closely held secret,” ProPublica’s Robin Fields reported. “There’s nowhere that a consumer or an employer can go to look up all insurers’ denial rates—let alone whether a particular company is likely to decline to pay for procedures or drugs that its plans appear to cover.”
“In 2010, federal regulators were granted expansive authority through the Affordable Care Act to require that insurers provide information on their denials. This data could have meant a sea change in transparency for consumers,” Fields added. “But more than a decade later, the federal government has collected only a fraction of what it’s entitled to. And what information it has released, experts say, is so crude, inconsistent, and confusing that it’s essentially meaningless.”
The data that is available indicates claim denials are on the rise. According to a February KFF study of Affordable Care Act plans, “nearly 17 percent of in-network claims were denied in 2021.”
Elisabeth Rosenthal of KFF Health News wrote in a column last month that declining to pay for patients’ treatments is “a handy way for insurers to keep revenue high.”
“Millions of Americans in the past few years have run into this experience: filing a healthcare insurance claim that once might have been paid immediately but instead is just as quickly denied,” Rosenthal wrote. “If the experience and the insurer’s explanation often seem arbitrary and absurd, that might be because companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims—sometimes bundles at a time—without reviewing the patient’s medical chart. A job title at one company was ‘denial nurse.’”
ProPublica noted Wednesday that “some advocates say insurers have a good reason to dodge transparency.”
Citing Wendell Potter, a former Cigna executive who now supports Medicare for All, ProPublica reported that “refusing payment for medical care and drugs has become a staple of their business model, in part because they know customers appeal less than 1 percent of denials.”
“That’s money left on the table that the insurers keep,” Potter told the outlet.
With their companies’ profits booming, the CEOs of the top seven private health insurance giants in the U.S. took home a combined $335 million in compensation last year.
Medicare Advantage providers—private insurers paid by the federal government to cover patient care—have become notorious for denying claims for medically necessary treatments as enrollment in the program continues to surge.
As The Lever’s Matthew Cunningham-Cook reported Wednesday, “Medicare Advantage insurers are threatening the foundational premise of the government’s healthcare safety net for seniors and people with disabilities: that people in Medicare should get the care that is recommended by a doctor.”
“A 2022 investigation by the inspector general of the Department of Health and Human Services found that in 2019, 13 percent of the total prior authorization requests denied by Medicare Advantage plans would have been covered under traditional Medicare, leading to an estimated 85,000 additional care denials,” Cunningham-Cook wrote. “That year, Medicare Advantage plans also wrongly denied 18 percent of payment claims—covering an estimated 1.5 million claims—reducing the likelihood that doctors will recommend the costliest yet often most effective care, for fear of not being paid.”
Social Security Works, a progressive advocacy group that backs Medicare for All, tweeted in response to the new reporting Wednesday that “private insurance companies, including Medicare Advantage plans, are designed to generate profit.”
“How do they do that? Take our money and then deny our care,” the group added.
Cunningham-Cook opened his piece with the story of Jenn Coffey, a former Republican state representative in New Hampshire “who, like many GOP faithfuls, believed private insurers could solve the healthcare crisis if they were allowed to do things like sell policies across state lines.”
But Coffey’s views were shaken when UnitedHealth, her ultra-profitable Medicare Advantage provider, “constantly rejected or second-guessed the care options her doctors suggested for her cancer recovery and for a rare and painful secondary disease that has no standard treatment plan,” Cunningham-Cook reported.
“Now I’ve realized that you can’t fix or repair the system,” Coffey told The Lever. “The insurance companies don’t offer anything. They serve as a roadblock.”
“The only way forward,” she added, “is Medicare for All.”
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Jake Johnson is a staff writer for Common Dreams. This work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.
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Listen up, lovers: time is not on your side. According to the Gutted Ghost of the Award-Winning Local Daily, the City of Portsmouth is about to break out the bolt cutters—all this hardware has got to go. Aside from the sentiment, most of these padlocks are of little intrinsic value. Whoever hung the antiques here, though, ought to retrieve their property ASAP.
UPDATE: On Tuesday, the beleaguered source cited above reported that the Seacoast Repertory Theatre “has pitched the idea of taking possession of the park’s padlock-adorned fence…to use on the set of its upcoming run of performances of the musical ‘Hair,’ and display the locks outside the theater in the future.” Might this Hail Mary succeed? The reader’s guess is as good as the editor’s. Probably better, in fact (see below).
POTENTIAL ALTERNATIVE OUTCOME: Considering the outlandish nature of current events lately, we’re not ruling out the possibility that Bill Paarlberg’s Piscatasquid! might extend a mighty tentacle from the depths and drag the fence to its undersea lair, locks and all.
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“Unprecedented Assault”: Republican Bills Would Create Loopholes for PFAS Polluters
by Olivia Rosane
Five new bills being considered by Congress this session could help industry find a way out of cleaning up dangerous “forever chemicals,” warns the Environmental Working Group.
The bills, introduced by Sens. Cynthia Lummis (R-Wyo.) and John Boozman (R-Ark.) May 4, would protect five key sectors from liability if the Environmental Protection Agency (EPA) moves forward with labeling certain per- and polyfluoroalkyl substances (PFAS) as hazardous substances under the Superfund law: water utilities, landfills, agriculture, airports, and fire training facilities.
“But far more than even these significant loopholes is at stake,” Melanie Benesh, vice president for government affairs at the Environmental Working Group (EWG), said. “Their bill would open the door to even more loopholes for companies that have used PFAS or other hazardous substances, making it much harder to clean up contaminated communities.”
PFAS are a class of widely used chemicals found in everything from firefighting foam to nonstick cookware. They are called forever chemicals because they do not break down easily in the environment, and they have spread to contaminate the drinking water of potentially more than 200 million Americans. A growing body of research links them to a host of health threats including cancer, immune suppression, and reproductive or developmental problems.
In recent years, regulators at the state and federal levels have taken steps to limit the spread of PFAS in the environment and clean up what’s already there. To that end, EPA proposed listing two PFAS—perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS)—as hazardous substances under the Superfund law, officially the Comprehensive Environmental Response, Compensation, and Liability Act, in August 2022.
Such a listing would trigger reportings of large releases of PFOA and PFOS and enable the EPA to require a cleanup and, in some cases, demand the polluter pay for it. Green groups at the time, including EWG, praised the move as historic, but argued the federal government could go further.
Now, EWG says Lummis and Boozman’s bills would not only weaken this initial attempt to regulate PFAS, but the strength of the Superfund law all together.
“More than PFOA and PFOS are at stake,” Benesh wrote for EWG’s website. “Since passage of the Superfund law, Congress has never created the kind of exemptions proposed by Lummis and Boozman. Their proposal would be an unprecedented assault on one of our benchmark environmental laws and open the door to similar loopholes for everything from PCBs to dioxin.”
In a statement, Lummis and Boozman argued that their bills would protect sectors that either did not contribute to PFAS contamination or were required to use substances containing PFAS.
“There is no doubt we need to consider the environmental impacts of PFAS chemicals but suing entities who did not contribute to the contamination is overkill, especially considering some of these entities, such as ranches and water facilities, are just downstream receivers,” Lummis said.
However, EWG argues that these extra liability protections are not necessary.
“The EPA already has leeway over which polluters it holds responsible for cleanup,” Benesh observed. “The agency has successfully used this discretion for over 40 years to ensure polluters pay the lion’s share of the cleanup under Superfund.”
In this case, the EPA has already promised to focus on manufacturers and government facilities rather than water utilities, farmers, fire departments, airports, or landfills. It also tends to settle quickly with innocent parties, which then protects them from being sued by outside groups.
What’s more, the bills would act as a “slippery slope,” as Benesh explained:
“The Lummis-Boozman bills apply to just five sympathetic sectors. But those aren’t the only ones clamoring for an escape from liability.
“For example, when Congress voted on the PFAS Action Act in 2021, Republicans offered amendments exempting medical devices, semiconductors, lithium batteries, solar panels, wind turbines, pipeline safety equipment, and chlorine production from Superfund. Now, if the Senate gives loopholes to sectors like water utilities and farmers, these other polluters will only be more emboldened to ask again for their own loopholes.”
Benesh said it was important to guard the Superfund law against a death by a thousand industry papercuts.
“We must protect Superfund to ensure contaminated communities get the cleanup they need and deserve,” Benesh wrote.
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Olivia Rosane is a staff writer for Common Dreams. This work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.
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So far as we know, the Constitution does not mention a right to hang unauthorized hardware from city infrastructure. That fact, and a full-time, taxpayer-funded legal staff, tend to suggest that the City will prevail in the matter of Portsmouth vs. Padlocks. On what grounds, though, can the City bar people from lounging around in folding chairs amid a display of flag code violations? Asking for some friends.
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Strafford County Power Grab
[Note: The following letter arrived a few hours after our Mash Notes, &c. had already been sent to the stalwarts of our Proofreading Department. We ruled out holding it for the next issue; it was too time-sensitive. Rather than disrupting our proofreaders’ workflow—not to mention re-paginating—we decided to treat the letter as news. – The Ed.]
To the Editor:
New Hampshire is a bastion of common sense and mutual cooperation in a time of national upheaval and distrust, but maybe that time has elapsed.
HB75 is a copy and paste of a HB270, a bill that was retained in committee in February of this year. It proposes a districting of Strafford County’s county commissioner seats, from three seats pulled from all of Strafford County—which is usually three Democratic seats—to two more-than-most-likely Republican seats and one strong Democratic seat. This was not done in the normal process. The public was not given reasonable notice of the bill. It was rushed to Committee of Conference, with entirely Republican members, which then quickly and quietly voted to pass the bill.
Additionally, the map chosen for creating the district did not seem to use non-partisan metrics; nor have the members of that committee released the metrics they used to make their decision. Though there are over 9,000 ways that Strafford county could be redrawn, the chosen and proposed map includes counting Durham and Dover Ward 4 as contiguous, ignoring that Madbury sits in between. It is not the most compact of districts, it does not look to keep cities intact or community identities together, but it does give Republicans two seats where they previously had none.
Granite Staters are a proud people that are unafraid of reaching across the aisle to do things necessary to benefit members of their community. HB75 is clearly nothing more than authoritarian power grab and has no place in our state. Redistricting is necessary to maintain up-to-date and competitive voting; however, it must be done with transparency and in good faith. Include the constituents impacted by these decisions in on the conversation. Democracy is not optional. Oppose Gerrymandering. Oppose HB 75.
Curtis Register
Durham, N.H.
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Star Island Mail Boat Tours Are Back
The Star Island Mail Boat run, from Pepperrell Cove in Kittery Point to Star Island in the Isles of Shoals, resumed services for the season on June 19th.
This will be the first full season for the brand new M/V Shining Star. The 27-ton, 46-foot vessel is a Mussel Ridge 46 design by New Castle, N.H. native Albert Hutchinson.
The trip takes about 45 minutes. Along with the mail, the boat carries freight, food, and island employees. Along the way passengers may see seals, porpoises, and even the odd whale here and there, along with seabirds like gannets, loons, and the occasional bald eagle.
The summer population of Star Island hovers around 400. Passengers will have about 45 minutes to wander about before returning, giving ample opportunity to view the largest off-grid solar power array in New England.
Morning trips—when the weather is generally calmest—run on Mondays, Wednesdays, and Fridays from now into September. They leave Pepperrell Cove at about 7:45 a.m. and return before 11:00 a.m. Tickets are $30 per person, children 12 and under are free.
Extended trips on Tuesday afternoons depart Pepperrell Cove at about 1:15, and return to Kittery Point about 6:00 p.m. They include an afternoon ashore, and a tour of the seal colony on neighboring Duck Island. Tickets are $40 per person, children 12 and under are $20.
All trips are by prior reservation. Space is often limited. For more information see SeacoastMaritimeCharters.com or call (207) 337-0446.
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“The real casualty of the Compromise of 1850 was the Whig Party, which would never again occupy the White House, although Abraham Lincoln was a former Whig. Fillmore, who had never sought, nor desired, the presidency, found himself as the only viable candidate to run on a Whig platform in 1852. No Whig could win the presidency without the support of the southern Whigs, and Fillmore, having supported the revised Fugitive Slave Act, had a southern credential to go with the largely pro-northern compromise. But Fillmore didn’t want the nomination, despite having gotten the majority of delegates. He tried, instead, to push his delegates toward Daniel Webster, but they refused. With nowhere else to go, the delegates cast their ballots in favor of Winfield Scott, who secured the nomination for the Whig Party’s final appearance in a national election. Thus Scott became the Whig nominee in 1852, who with William Seward’s endorsement was guaranteed to lose all support from the southern Whigs. The party was dead and Franklin Pierce—an unremarkable pro-slavery Democrat—easily won the election in 1852. On January 6th, just two months before taking office, Pierce’s eleven-year-old son, Benjamin, was killed in a train accident. Thus, Fillmore’s presidency began and ended in the White House draped in black mourning cloth. Pierce never recovered from this loss and neither did his wife, who would tragically be referred to as a White House ghost. He was a melancholy president, a sporadically functional alcoholic, who in his one high-profile decision signed the Kansas-Nebraska Act in 1854, which had the effect of pushing the country closer to civil war.”
– Jared Cohen, Accidental Presidents: Eight Men Who Changed America (2019)