We’ve been discussing for months how hospitals and health systems are contending with the worst financial crisis in their history as they continue to serve on the front lines of the fight against COVID-19. A June AHA report projected that hospitals would lose at least $323 billion this year — and that number could very well be an underestimate — as the analysis at the time did not account for potential surges in COVID-19 cases like we are experiencing now.
For health insurers, the financial impact of COVID-19 paints a very different picture. Many health insurers are not spending nearly as much on care as they anticipated when they set their 2020 premiums, and several analysts and health plans alike believe the pandemic will be financially positive for the health insurance industry.
In addition, a number of health insurer tactics put in place before COVID-19 have financially aided the plans during this time, and several health insurers have even taken steps to expand such policies during the pandemic. These include denials for emergency services, denials for early sepsis interventions, questionable reporting requirements, and abuse of utilization management tools to delay and deny payment.
Despite the health care system’s tremendous financial struggles overall, some health insurers are treating this excess revenue like they would under normal circumstances — using it to engage in stock buyback; paying down debt; and stockpiling excess premium dollars into their reserves. However, these times are anything but “business as usual,” and these dollars are needed to keep our health care system solvent.
The House Energy and Commerce Committee is investigating health insurance companies’ performance during the COVID-19 pandemic, and we recently urged the committee to ensure insurance premiums support access to care. Specifically, we recommended action to require insurers to:
- immediately process payment for all outstanding claims;
- transition to biweekly and/or accelerated payments at a provider’s request;
- suspend utilization management tools and administrative processes that present barriers to care and burden providers;
- and prohibit emergency care denials based on retrospective reviews.
As we have said throughout the pandemic … on a variety of different issues … we are all in this together. Hospitals and health systems — and their brave front-line caregivers — will keep working every day to care for their communities. We need health insurers to do their part too and put patients’ needs before their profits.