OPINION:
As a physician with 35 years of experience, I have dedicated my life to serving others, primarily in rural and underserved communities. Now, instead of spending time fighting disease, we spend more and more time fighting insurance companies’ ever-increasing obstruction.
A few months ago, the House Ways and Means Committee hosted representatives from UnitedHealth Group, Elevance Health, Cigna and CVS Health for a hearing on healthcare affordability. During my time, I exposed the unconscionable practices of these mega corporations to squeeze every last penny out of patients and physicians in the name of profit.
Medicare Advantage began with a good idea, but increasingly bad actors abuse the program and patients who rely on it by denying care through progressively burdensome prior authorizations. These denials, just like their companies’ profits, have been on the rise in recent years, creating heartbreaking barriers to lifesaving care for patients.
In 2024, Medicare Advantage insurers denied 4.1 million prior authorization requests. Although roughly 80% of appeals were eventually overturned, it was only after patients and caregivers were forced to spend expensive and oppressive amounts of time fighting for care. Sadly, because of these practices, many patients give up in frustration and do not receive the care they need and have paid for. Insurance companies depend on the surrender.
I am far from the only physician ringing the bell on this travesty. A recent survey showed that 95% of doctors say prior authorization leads to care delays, and 79% say it sometimes causes patients to abandon recommended treatment. Nearly 1 in 3 report that authorization delays have contributed to a serious adverse event. Yet insurance companies deny they practice medicine. They absolutely do by preventing patients from getting the care their doctors prescribe.
The current state of prior authorization allows insurers to deny care to pad their profits. I commend the Trump administration for bringing insurers to the table last year to improve this process. Health and Human Services Secretary Robert F. Kennedy Jr. and Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, have taken laudable action to rein in this abuse. Sadly, I do not trust the health insurance giants, and we must hold them accountable.
Although I am not a Medicare Advantage beneficiary, I have spoken many times about the systematic denials and delays in care that I have experienced. Last year, I shared that I have a significant endocrine disorder myself, and a drug my endocrinologist prescribed to keep me alive. I purposely chose not to use my membership in Congress to receive special treatment but endured the hardship millions of Medicare Advantage patients experience each year. Most patients give up after two denials. I kept going to see how long it would take to get what I needed. Finally, after eight denials, I got the medicine I needed. No one should have to go through such nonsense.
I understand that there are outliers who overbill and overorder, driving up costs, but the response cannot be to create a process that delays and denies care to the vast majority who do it right. The current process is harming patients and pushing physicians out of practice.
As co-chair of the GOP Doctors Caucus, I serve as a physician-legislator, giving us a unique perspective on how the healthcare system delivers and finances care. Medicare Advantage was well-intentioned, but abuses by health insurers are contributing to its failure to meet consumers’ reasonable expectations — all in the name of profit. Congress must be bold in its actions to deliver meaningful solutions that make healthcare work for all Americans.
• Rep. Greg Murphy, M.D., represents North Carolina’s 3rd Congressional District. He is the only practicing surgeon in Congress, a member of the House Ways and Means Committee and co-chair of the GOP Doctors Caucus.
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