New poll reveals Americans don’t want insurers to limit treatment decisions
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As the new administration and Congress look to improve our health care system, they must ensure addressing health insurance barriers many Americans face in accessing prescribed treatment remains a top priority. Federal and state policymakers now have an opportunity to improve care if they listen to the patient voice. 

A new poll, conducted by the Alliance for the Adoptions of Innovation in Medicine (Aimed Alliance) in conjunction with David Binder Research, shows that many Americans hold their health insurers to high standards and expect to receive quality care—conveying a disconnect between expectations and reality.

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While 89 percent of respondents said they knew where to find their health plan, 54 percent said they did not understand the plans’ coverage and copay policies. Another 26 percent said they expected a medication or treatment to be covered only to later find that it was not.

There appears to be a false paradigm about the role insurers play in the health care process.  Consumers pay premiums to “insure” that adequate coverage will be there when they need it. In fact, 93 percent said they expect their insurers to cover prescribed care, and 96 percent said the patient and his or her health care provider should make treatment decisions without a third party intervening. Yet, in actuality, this is not always the case.

Insurers can subjectively deny treatment that health care providers prescribe to their patients and force “unprofitable” patients into therapies that are less expensive and potentially less effective. For example, through a policy known as “step therapy,” insurers can require patients to try and fail on less expensive treatments before they will cover the prescribed medication—a practice that 59 percent of survey respondents opposed.

Using another practice, called “nonmedical switching,” insurers can force stable patients to switch from their current medication to a different (but not necessarily generic) drug by either dropping coverage or increasing the out-of-pocket cost of the drug after the plan year has begun—a practice that 92 percent of respondents opposed. Many Americans are unaware of such practices. Yet, the consequences can be a hassle to deal with and, in some cases, detrimental to a patient’s wellbeing.

This does not mean Americans should not have “skin in the game,” a sentiment shared by the president-elect’s leading candidates to helm HHS and CMS. The poll showed many Americans do value innovative treatments, even if it means paying more for them. As a result, at least 27 percent filed an appeal of an adverse coverage determination, while 77 percent were willing to appeal.

However, this is a temporary fix to a larger problem. To prevent Americans from needing to heavily rely on the appeals process in the first place, policymakers must ensure proper protections are in place. To protect patients from improper interference from insurers, any new federal health care law must include key components of ObamaCare, including preexisting condition protections (supported by 88 percent of survey respondents) and the prohibition on discrimination based on health condition (supported by 93 percent of respondents).

To limit insurance practices that impede access to quality care, state policymakers must enact strong consumer-protection laws, including laws that specifically address step therapy and nonmedical switching.  Americans are willing to compromise and pay more for innovative treatment if treatment decisions remain between the practitioner and the patient. What American don’t want is insurers, the government, or institutions making health decisions for them.

There is an inherent absurdity that someone who never examined you would have the authority to override the decision of a trained medical professional with an intimate knowledge of your condition.  As lawmakers move ahead with changes to ObamaCare, we urge them to examine what role insurers should have in the patient-care decision making process.  The answer is fairly simple…None. 

Stacey L. Worthy, Esq., is executive director of Aimed Alliance.


The views expressed by authors are their own and not the views of The Hill.