Pa. joins states eyeing oversight of insurers
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Mounting public anger over health insurance is leading more state legislatures to eye tighter oversight of the industry, starting with its use of AI to screen claims and issue denials.
Why it matters: While congressional scrutiny of the industry picked up following the killing of UnitedHealthcare CEO Brian Thompson, states remain the primary regulators of health insurance and are best positioned to address access to and adequacy of care.
The big picture: Even before Thompson's killing revealed widespread anger over insurer decisions, states were targeting prior authorization and tools health plans use to manage care, with more than 90 different bills proposed nationwide last year, according to Georgetown University's Center on Health Insurance Reforms.
Zoom in: In Pennsylvania, House Bill 1663 would require state-regulated insurers to publicly disclose and define AI tech used to evaluate claims.
- The bill would also require health care professionals who review claims for insurance companies to personally examine each clinical record, documenting their own reason for a denial.
- The Pennsylvania Insurance Department has issued some guidance for insurers on the use of AI, based on a model released by the National Association of Insurance Commissioners.
- This legislation would put more explicit state-level rules in place.
Zoom out: In New Jersey, state-regulated health insurance companies will have to decide more quickly — within 72 hours — whether they will cover a test or treatment recommended by a patient's doctor.
- A slew of health insurance reforms took effect at the start of the year in Illinois, including a ban on "step therapy," where patients have to use cheaper drugs before being approved for more expensive ones.
Between the lines: The state efforts are expected to outpace those in the new Congress, in part because state legislators tend to face less pressure covering the costs of changes in insurance law.