Health Insurance Company Medicare Advantage Denials

Floor Speech

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Mr. MURPHY. Mr. Speaker, I rise today to continue to shed light on the egregious practices of our health insurance industry companies that continue to deny patients care and rip off the American taxpayers.

I have been practicing medicine now for 35 years and have dedicated my life to serving others, primarily those in rural and underserved areas. American medicine is sick. American medicine is unaffordable.

A few months ago, the House Ways and Means Committee hosted representatives from multiple insurance companies to deal with healthcare affordability. During that time, I exposed the unconscionable practices of these megacorporations that squeeze every penny out of patients and physicians for their own profit.

Today, I want to talk about the bad actors in Medicare Advantage, a program that seeks to prey upon the elderly and those who have health insurance issues as they get older, that rely on prior authorizations as a way to deny care.

These denials have been up in recent years, as have been, amazingly enough, insurance company profits. They have created barriers to lifesaving care for patients.

In fact, in 2024, Medicare Advantage insurers denied over 4 million prior authorization requests. Yet, when appealed, over 80 percent of those were overturned. This was only after patients and caregivers were forced to fight for the care that they deserve. Sadly, many give up, and they don't receive the care that they need and the care that they have paid for.

I am far from the only physician ringing the bell on this travesty. Recent surveys show that 93 percent of doctors say that prior authorization leads to care delays, and 82 percent say that it sometimes causes patient harm. Nearly one in three state that delays have contributed to a serious adverse safety event.

The current state of prior authorization allows insurance companies to deny care and pad their profits.

I commend the Trump administration for bringing insurance companies to the table and forcing them to improve their process. Sadly enough, I don't believe a word that these insurance companies say because they are ever increasingly putting profits above patients.

I understand that there are bad actors and those who overbill the system. I truly do. They overorder to drive up costs. The response cannot be a regime that continues delays and denies care for patients who deserve to be healthy.

Congress must be bold in its action to deliver meaningful and lasting solutions to make healthcare work for all Americans.

I am proud to have introduced the Medicare Advantage Improvement Act with my friend and colleague, Dr. John Joyce. As co-chairs of the GOP Doctors Caucus, our unique experience as physician-legislators gives us perspective on how the healthcare system delivers and finances care.

MAIA streamlines Medicare Advantage prior authorization by enabling real-time approvals for routine care, setting up clear decision guidelines and preventing repetitive reauthorization denials, denials, denials. It also strengthens network adequacy and access centers so that seniors can obtain the full spectrum of medically necessary care when they need it.

Healthcare is expensive. We are living longer because of wonderful innovations in healthcare. Yet, sadly enough, vertical integration and the middlemen are destroying the American healthcare system. We don't need to be padding the profits of middlemen, be they insurance companies, be they PBMs, or be they any individuals in the middle who are siphoning off profits away from patients and away from those who care for patients.

We need to get back to a system that is streamlined, and we need to stop paying those who deny patient care.

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