Many blame insurance companies for the increasing denial of claims and obstacles to healthcare access. However, a closer look reveals that politicians bear the true responsibility for this troubling trend.

Before the Affordable Care Act (ACA) took effect in 2013, claim denials were around 1.5%, according to the American Medical Association. Under the ACA, this number has skyrocketed to nearly 15%, with some insurers denying a third or more of claims. The rise in preauthorization requirements for treatments and medications further complicates matters, often leading to dangerous delays in patient care.

Physicians are frequently forced to seek preauthorization from insurance representatives who lack specialized medical knowledge, sometimes leading to inappropriate overrides of doctors' recommendations. This can have devastating consequences, as illustrated by the case of a doctor who had to wait weeks for approval for a crucial drug combination for a patient with metastatic breast cancer, ultimately resulting in the patient's death.

While Cigna's high rate of overturned preauthorization denials suggests that legitimate care is being withheld, the blame doesn't lie solely with insurance companies. The ACA's regulations on underwriting profits, which require rebates to customers if profits exceed a certain threshold, limit the extent to which insurers can prioritize profit maximization.

The core issue lies in the ACA's promise of equal coverage regardless of pre-existing conditions. This promise ignores the fundamental reality that a small percentage of the population accounts for a disproportionately large share of healthcare costs. This makes it unsustainable to charge the same premiums for everyone, akin to charging the same price for groceries for someone with vastly different consumption needs.

Instead of providing additional funding to cover those with pre-existing conditions, the government placed the burden on insurers, forcing them to adopt cost-cutting measures. While this fulfilled a popular political promise, it has led to detrimental consequences for patients, particularly those with serious illnesses.

While some states are taking steps to limit preauthorization requirements, a more fundamental reassessment of managed care is needed. Alternatives, such as low-cost catastrophic insurance, should be considered to provide more affordable and flexible options for healthy individuals. It's time to recognize that health plans that consistently deny claims and delay necessary care are the real "junk insurance."