Tag Archives: health-insurance

Trump again makes it harder for the rest of us

22 Jun

Trump’s new ACA rule piles on red tape, drops 2 million people from coverage, and greenlights ultra-high-cost, no‑network plans; the article unpacks how these changes shift power to insurers.

The Trump administration finalized extensive new Affordable Care Act marketplace regulations on May 20, 2026, that impose new administrative burdens on consumers while granting unprecedented flexibility to health insurers. The rule arrives as marketplace premiums have doubled after Congress cut funding for premium tax credits, causing enrollment to decline for the first time since 2020.

The new rule projects that added paperwork and verification requirements for millions of low-income enrollees and most midyear applicants will cause up to 2 million people to lose coverage. Research shows these administrative burdens disproportionately drive younger, healthier consumers out of the insurance market. As the remaining insured pool becomes relatively sicker, the cost of coverage rises for everyone.

At the same time, the administration relaxes consumer protections and insurer standards in several novel ways. Starting in 2027, bronze plans may impose out-of-pocket maximums at 130 percent of the statutory limit—$15,600 for individuals and $31,200 for families—with catastrophic plans required to match these levels in 2028. The rule also permits “nonnetwork” plans where all providers are out-of-network, exposing enrollees to surprise medical bills for nearly all non-emergency care while depressing the benchmark that determines premium tax credits for all consumers. Additionally, insurers can now market skimpy catastrophic coverage to most adults, regardless of age or prior hardship restrictions, and may offer multiyear catastrophic plans lasting up to 10 years. The rule even suggests consumers could request loans from insurers to cover unaffordable deductibles.

Several of these policies face immediate legal challenges, with plaintiffs arguing that the changes exceed administrative authority and lack adequate justification. The rule reveals clear priorities: reducing marketplace enrollment through consumer red tape while allowing insurers to shift more costs and risks to enrollees.

Read the details in the full 1,121-page report here:
https://www.cms.gov/files/document/cms-9883-f-patient-protection.pdf

An easier-to-read analysis:
https://www.healthaffairs.org/content/forefront/hhs-finalizes-sweeping-marketplace-changes-part-1-higher-bronze-deductibles-and

The Commonwealth Fund report on this rule change:
https://www.commonwealthfund.org/blog/2026/trump-administrations-new-aca-marketplace-rule-gives-insurance-companies-flexibility

Tags: , , , ,

AI in Healthcare

19 Jul

Two articles to help healthcare consumers understand how artificial intelligence is impacting the healthcare you receive.

The first one explains how insurance companies use AI to control the services you receive through prior authorization and denials of care. The second one provides you with an AI resource to appeal denials of of care and, in many cases, get the appropriate care approved.

Prior authorization is a process used by health insurance companies that requires health care providers to obtain advance approval from the insurer before a specific medical service, treatment, procedure, or prescription drug will be covered for payment. This means your doctor or provider must get the health plan’s permission before you receive certain medical care or medications, except in emergencies.

The main purposes of prior authorization are:

  • Controlling costs for the insurance company
  • Ensuring medical necessity, safety, and cost-effectiveness of the requested care
  • Sometimes, verifying that less expensive or safer alternatives have been tried first.

This process is also referred to by names like preauthorization, preapproval, or precertification.

“Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care,” said AMA President Bruce A.Scot, MD. Your physician should be able to make medical decisions with their patients without interference from unregulated and unsupervised AI technology.

This article describes how insurance companies use AI to limit the care you receive:
https://theconversation.com/how-artificial-intelligence-controls-your-health-insurance-coverage-253602

If prior authorization is not obtained, the insurer may refuse to pay for the service or medication, leaving the patient responsible for the cost. The responsibility for requesting prior authorization typically falls on the provider, who must submit documentation to justify the request.

Prior authorization can lead to delays in care, and approximately a quarter of these requests are initially denied; however, denials can often be appealed and overturned.  Marketplace plans under the Affordable Care Act denied 19% of in-network claims in 2023, the most recent year for which data is available. Fewer than 1% of consumers appealed the denials, the research found, but when they appealed, over half the denials — 56% — were upheld.

This article gives you an AI tool that is effective in reversing denials of services that you need:
https://www.nbcnews.com/news/us-news/ai-helping-patients-fight-insurance-company-denials-wild-rcna219008

Claimable, a private company, is a pioneering healthcare technology company founded in 2024 that leverages artificial intelligence to help patients overturn unjust health insurance claim denials. The company launched its AI-powered appeals platform on October 2, 2024, marking a significant milestone in making healthcare appeals more accessible and effective for patients nationwide. This gives you the power of AI to overturn denials of care.

Tags: , , , ,