CHA launched Healthcare Here at healthcarehere.org on Oct. 23 along with its partners in the Alliance for Access to Care. The alliance includes the American Hospital Association and other health care providers and patient advocacy groups.
The idea for Healthcare Here came about earlier this year after a CHA affinity group meeting of Catholic health system CEOs. They had long heard from patients and clinicians about the impact commercial insurance denials have on the ability to access care. The leaders also pointed to distortion and disinformation campaigns from activists and for-profit commercial insurance providers over the last year, at a time when nonprofit hospitals nationwide have faced two years of near-record financial losses.
"This initiative was created after hearing from our members about the increasing impact commercial insurance denials are having on their patients and their ability to care for them," said Sr. Mary Haddad, RSM, CHA's president and CEO. "These barriers to coverage are limiting access to care. So the main goal of this public awareness campaign is to amplify the patient perspective and elevate the essentiality of our member hospitals."
The campaign will roll out initially in three target markets with a heavy concentration of Catholic health care facilities.
The campaign points out that insurance companies profit from denying care. Healthcare Here says that commercial insurers have raised premiums 14.5% over the past five years, and that average denial rates increased by 23% between 2016 and 2020. The campaign website cites a study from Becker's Payer Issues that says profits from several major carriers went up 7% to 70% in 2022.
Healthcare Here says: "While physicians take an oath to prescribe beneficial treatments for their patients, it's the commercial insurance companies who get the final say on what treatments are covered — sometimes to the detriment of patient health."
It points to a survey of 1,000 doctors from the American Medical Association in which 94% percent said prior authorization delayed access to medical care and 80% said prior authorization had led patients to abandon recommended care.
Hospitals under strain
Healthcare Here says in 2019 nonprofit hospitals got $12.4 billion in federal tax exemptions. In the same year, nonprofit hospitals dispersed more than $110 billion to community health programs.
"Catholic health care in the U.S. has always attended to the needs of their communities and has led the way in addressing the social and environmental issues that impact health," Sr. Mary said. "The community benefit investments our members make include not just charity care, but also programs that address chronic illness, poverty, health disparities, housing support, food insecurity and other factors that influence a person's health."
While insurance companies are largely profiting from the current system, many hospitals are feeling the pinch. Healthcare Here says the median operating margin of hospitals, which is the proportion of revenue left after costs, is 1.3%. More than 30% of the nation's rural hospitals are at risk of closure, according to the Center for Healthcare Quality and Payment Reform.
The American Hospital Association says hospital expenses per patient for things like labor, drugs and supplies increased 20.1% from 2019 to 2021. Over the past 10 years, yearly commercial health insurance premiums have increased at twice the rate as the yearly rise in hospital prices.
Healthcare Here says sometimes an insurance company's algorithm, not a person, denies treatment coverage. The campaign website cites a ProPublica investigation that said Cigna used an automated system and spent an average of 1.2 seconds per case to deny more than 300,000 claims.
Healthcare Here urges people to contact state and federal representatives and provides a template for a message to them.
Said Sr. Mary: "Ideally, all sectors of the health care system should be working together to deliver affordable, accessible, and high-quality care for patients. Through this campaign, we want the public and the policymakers they elect to understand how profit-driven actors are manipulating the health care system, which in turn is harming patients and the local hospitals that care for them."