Health insurers point fingers over affordability woes

• That's raising the temperature for health plans already getting blamed for coverage denials and other business practices.

State of play: Insurers and employer-backed advocacy groups such as Better Solutions for Healthcare and its Hospital Watch initiative are running ads pointing out hospitals' outsized presence in some markets, with messages like "hospital monopolies put profits over patients."

• Insurers also are touting voluntary moves they've made to cut down "prior authorization" reviews of doctor-ordered treatments.
• An insurer-aligned group called Affordable Health Care Initiative is running ads with the message "we understand why you're frustrated" and "America's health insurers are on the side of people, working hard to negotiate costs down."

What they're saying: "Health care costs too much ... so that scrutiny is valid and needed, and we embrace that," Mike Tuffin, CEO of AHIP — the insurers' big Washington lobby — told Axios.

• "The most effective message is rooted in the plain facts about the causes of rising health care costs in the U.S.," he added.
• Those are "anticompetitive practices by multinational brand drugmakers" and "opaque and sometimes deceptive practices by certain hospital systems," he argued.

Between the lines: The Affordable Health Care Initiative is backed by UnitedHealth Group, sources say. A UnitedHealth spokesperson declined to comment.

• Within the industry, there is some disagreement over how best to push back.
• Some have expressed doubts about whether the upbeat tone of the group's ads resonates with an increasingly frustrated public.

The big picture: Insurers were the first industry group called before Congress to testify earlier this year as House Republicans held a series of hearings on health care costs.

• Those hearings revealed bipartisan eagerness to address vertical consolidation — when insurers own pharmacy benefit managers that negotiate drug prices and pay pharmacies, and even health providers — as well as to limit prior authorization reviews.
• "Time to break up big insurance," Sen. Ron Wyden (Ore.) the top Democrat on the Senate Finance Committee, wrote on X.
• But UnitedHealth CEO Stephen Hemsley responded in testimony that the cost of health insurance is driven by the cost of health care and that "it is a symptom, not a cause."

Health economists say the fundamental problem is the higher prices Americans pay for care and services compared with peer countries.

• Insurers argue that they play a key role keeping providers in check, by effectively capping what hospitals and drug companies can charge.
• But delays and denials of care, which insurers argue are sometimes needed to control costs and cut down on unnecessary procedures, are a huge source of frustration for patients.

The intrigue: Other health industries are trying to tap that sentiment and focus the blame on insurers for rising costs.

• "It's no surprise that large commercial insurers are trying to shift attention away from their own abysmal record," said American Hospital Association CEO Richard Pollack.
• The hospital-backed Coalition to Strengthen America's Healthcare is running ads hitting insurers for "putting your health care on hold" with delays and denials.
• Drug companies have long portrayed pharmacy benefit managers and insurers as bad actors, saying they siphon off drug spending to pad their profits.
• "Anyone in this room who has tried to engage the health care system knows it's opaque and it's complex, and that complexity drives cost," Bristol Myers Squibb CEO Chris Boerner said at Axios' Future of Health Summit this month.

The bottom line: It's not surprising that health industries are blaming each other for affordability woes, said Jonathan Burks, executive vice president of economic and health policy at the Bipartisan Policy Center and a former chief of staff for Speaker Paul Ryan.

• "Everyone is a little bit guilty of contributing to a system that people generally are not terribly satisfied with," he added.