Indiana among states cranking up oversight of health insurers
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Mounting public anger over health insurance is leading more state legislatures to eye tighter oversight of the industry, including its use of AI to screen claims and issue denials.
Why it matters: While congressional scrutiny has picked up, states remain the primary regulators of health insurance and are best positioned to address access to and adequacy of care.
The big picture: States have already been targeting prior authorization and other tools health plans use to manage health care use, with more than 90 different bills proposed nationwide last year, according to Georgetown University's Center on Health Insurance Reforms.
- The killing of UnitedHealthcare CEO Brian Thompson revealed widespread anger over insurer decisions.
- The calls for action are being amplified by physicians and other longtime insurer antagonists.
- "With both sorts of pressures pushing on [state] legislators to take some action, I do think we're likely to see more bills advance in the 2025 legislative session," said Sabrina Corlette, co-director of Georgetown's center.
Zoom in: After several years spent focused on health care costs, Indiana lawmakers convened a task force in 2023.
- The group's recommendations focused on increased transparency across the industry and standardizing prior authorization.
- This session, bills to increase oversight of pharmacy benefit managers and restrict the use of prior authorization by insurers are moving.
Yes, but: A bill that would require a health care provider or insurer to disclose the use of artificial intelligence to make or inform any decision involved in the provision of health care or coverage has yet to be heard.
- There's one more week for House Bill 1620 to be considered before the House's deadline for bills to move out of committee.
Between the lines: State efforts to oversee health insurers are expected to outpace those in the new Congress, in part because legislators tend to face less pressure covering the costs of changes in insurance law.
- The Trump administration and Republican Congress also aren't expected to make insurance reforms key parts of their early policy agenda.
The latest: California has already prohibited the use of AI for coverage denials, and Bloomberg Law reported that lawmakers in Georgia, New York and Pennsylvania are vowing to bring up the issue this year.
The other side: The insurance industry has said the use of AI can improve customer experiences, speed the claims process and detect fraud.