This story was originally published by KFF Health News.
by Lauren Sausser and Renuka Rayasam, KFF Health News
One year after the Trump administration announced that dozens of health insurers had signed a six-part pledge promising to reduce barriers to doctor-recommended care, some insurers now say they won’t implement all the promised initiatives.
Meanwhile, patients, their advocates, and clinicians say little has improved. “It has never been this bad for patients,” said U.S. Rep. Greg Murphy (R-N.C.), a physician who co-chairs the GOP Doctors Caucus.
The overarching intent of the June 2025 pledge was to improve a controversial process called prior authorization, which regularly requires patients or someone on their medical team to seek approval from insurers before proceeding with treatment. According to AHIP, the health insurance industry trade group, health plans have eliminated 6.5 million prior authorizations for patients — equal to an 11% reduction — since the announcement.
But critics remain skeptical. Sally Nix, a patient advocate who has a chronic disease, described the voluntary pledge as “performative.” Murphy, who participated in the news conference with Health and Human Services Secretary Robert F. Kennedy Jr. announcing the pledge last year, said it has “no teeth.”
Voluntary insurer pledges rarely make things better for patients, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University. “In the absence of clear rules, policies, standards, and mandates,” she said, insurance companies can quietly scale back commitments.
Last year’s industry pledge was organized as a direct response to public anger, Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said when it was announced. “There’s violence in the streets over these issues,” he said. “Americans are upset about it.”
Mike Gartner, founder of Health Access Innovation, an organization that helps patients overturn insurance denials, said he doubts that insurance companies are changing their policies in meaningful ways. The 11% reduction in prior authorization cited by AHIP “hides a lot of nuance,” Gartner said. Patients who need the costliest services, such as cancer treatment, are still being disproportionately denied access to doctor-recommended care, he said.
AHIP said its data included reductions in prior authorization for medical services, not prescription medicines, and didn’t provide details explaining which insurers had scaled back which commitments.
Real cases illustrate the stakes. When a Minnesota mother, Adler, tried to get a referral honored for her critically ill daughter’s care through Medica, she said an insurance representative first claimed no referral had been submitted, then said the insurer’s fax machine was down. “I have a critically ill child,” Adler remembered thinking. “I can either spend my emotional energy at war with Medica, or I can let it go and just enjoy my time with my daughter.” A Medica spokesperson said the company is “committed to working with her to ensure she understands what is covered under her benefits.”
In another case, a New York patient named Austin who completed inpatient substance-abuse treatment that her insurer, Independent Health, had approved was later billed more than $12,000 after the insurer said the services provided were “inconsistent with the care that was authorized.” Her approval letter had specified that “authorization is not a guarantee of claim payment.”
None of the insurers that pulled back on commitments agreed to interviews for the report, but most sent KFF Health News statements indicating they remain committed to prior authorization reform in principle, even as they cite technical and operational hurdles to specific standardization requirements.
Read the original story at KFF Health News.
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