Obamacare’s control of the health, and lives, of Americans largely has been diminished under President Trump, although it has not faced an outright repeal.
The individual mandate has been torpedoed, raising anew all sorts of questions about how government regulations and requirements were supposed to improve peoples’ health.
But there still are leftovers.
And they are injuring patients, according to an expert in the field.
One of them is the demand from corporate insurance powers that physicians get prior authorization for permission to treat patients.
“[Prior authorization] endangers patients,” warned Twila Brase, chief of the Citizens’ Council for Health Freedom.
“According to an American Medical Association study reported this month, 92 percent of physicians believe PriorAuth has a negative impact on clinical outcomes. Waiting for permission from a health plan delays treatment. Importantly, 72 percent of surveyed physicians in May said PriorAuth can lead patients to abandon a recommended course of treatment,” she said.
The idea of prior authorization is legitimate, in that insurance companies might be able, when asked to approve a treatment, offer a better solution, a new treatment, a less dangerous drug.
But that’s not what’s happening, she explained.
“To get access to the health plan’s captive enrollees, physicians sign contracts with plans that often require them to comply with the plan’s prior authorization requirements. These requirements often hurt patients, and are wholly unethical,” she explained.
“Prior authorization (‘PriorAuth’) is the process that requires physicians to ask the health plan for permission to treat the patient the way the physician – the only one in the room with the patient and the only one with a professional obligation to the patient – believes the patient should be treated. In short, PriorAuth is how the health plan controls doctors, restricts access to care, and generates profit,” she said this week.
Congress has jumped aboard.
“Single-payer supporter, Sen. Ted Kennedy got the HMO Act of 1973 passed to establish HMOs, now called health plans, nationwide. HillaryCare would have used HMOs to run a national health care system. Medicare Advantage (the HMO/health plan version of Medicare) became law in a GOP Congress. The Democrats’ Affordable Care Act (ACA) forced almost everyone into a health plan and gave them billions in federal subsidies. And most GOP ‘repeal’ proposals include continued generous taxpayer-funded subsidies to health plans through ACA ‘state innovation’ grants,” she said. “This redistribution program to enrich health plans is called ‘reinsurance.'”
“PriorAuth is a menace to patients and doctors alike,” she said.
Brase, who repeatedly has battled over medical privacy and related issues, pointed out the AMA got comments from two people:
“When I started here the only procedures requiring prior authorizations were surgeries,” wrote Robin S., who works at a urology practice. “Now medications, radiology and in-office procedures require prior authorization or you do not get paid.”
“I have had to make multiple calls and wait as long as two weeks trying to obtain authorization for an MRI when there were abnormal mammogram or pelvic sonogram findings,” wrote Dr. Nina S.
Brase noted the United States doesn’t have a single-payer system. Yet.
“But we are embracing a corporate version of socialized medicine, causing delays, denials, and dangerous outsider control of doctor’s decisions. In a free society, this is unacceptable.”