The U.S. Department of Health and Human Services has secured a pledge from insurers to streamline the companies’ practice of requiring prior authorizations before covering a claim.
“Americans shouldn’t have to negotiate with their insurer to get the care they need,” said HHS Secretary Robert F. Kennedy Jr. in a June 23, 2025, news release. “Pitting patients and their doctors against massive companies was not good for anyone.”
Consensus Plan
Kennedy and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz met with industry leaders on June 23 to secure a pledge to make six key reforms to cut red tape, improve transparency, and speed up the process for Medicare Advantage, Medicaid managed care, insurers on the Obamacare marketplace exchanges, and commercial plans.
The agreement will cover eight out of 10 Americans, the release states.
The insurers agreed to implement a common, transparent submission process for electronic prior authorization, reduce the scope of claims subjected to prior authorization, ensure continuity of care when policy enrollees switch plans, provide real-time responses, and agree to a review by doctors for claim denials.
Rather than issuing a rule, the administration has secured a voluntary pledge from the industry in much the same way it secured pledges from food manufacturers to remove potentially hazardous food dyes, under the implied threat that if the industry did not voluntarily comply with the request, rules could be forthcoming.
‘Kafkaesque’ Process
Ending prior authorization has been a top priority for Kennedy. Patients and doctors have long complained about the practice, says Jeff Childers, an attorney and author of the Coffee & Covid Substack. “[Prior authorization is] like a medieval drawbridge guarded by a somnolent scribe who only checks his scrolls on Thursdays,” wrote Childers.
“If your request doesn’t use the exact right incantations—procedure code 27447, subparagraph (c)—the bridge stays up and your treatment stays locked down,” wrote Childers. “Never mind the urgency, the medical need, or the fact that your kneecap is currently moonlighting as a paperweight. In short, pre-authorization is not insurance. It’s Kafkaesque permission-based medicine, wrapped in red tape and faxed to a disconnected number nobody checks anyway.”
Pre-authorization is a symptom of highly regulated health insurance run by private companies, says Matt Flanders, legislative and policy director for the Citizens’ Council for Health Freedom.
“Prior authorization delays access to care, undermines the expertise and medical training of physicians, and ultimately leads to a rationing of care,” said Flanders.
“It is the direct consequence of a third-party payment system where patients are not in control of the dollars being used to pay for their medical care,” said Flanders. “With real indemnity insurance, a patient is paid by the insurance company when they experience an insurable medical event, and they use the funds to pay their medical bills, just like every other insurance plan you purchase, including home, auto, and so forth.”
Industry Incentives
Although many health care analysts have applauded the pledge negotiation, the health insurance industry is a powerful force that will resist real change, says Mark Blocher, medical ethicist, author of Missional Medicine, and co-founder of Christian Healthcare Centers, a nonprofit direct primary care provider.
“Despite medical insurers’ recent pledge to reform the way prior authorizations interfere with patients getting the care they need in a timely manner, those assurances have all the trustworthiness of a Mexican drug cartel,” said Blocher.
“Insurance companies exist to make money, and they collude with large hospital systems, drug companies, and medical device manufacturers to expand control over millions of lives,” said Blocher. “No promise or pledge will keep them from pursuing the rampant profiteering that exists in health care to the detriment of patients and frustration of doctors. If there is to be true reform, it will require rules that transcend any one administration. People don’t do what is expected; they do what is inspected.”
Are Pledges Enough?
Flanders likewise says he is skeptical voluntary pledges will ensure compliance.
“A voluntary pledge to reform the prior authorization process is at best using a band-aid to attempt to fix an injury where surgery is required,” said Flanders. “In this case, the necessary surgery is to remove the health plans [HMOs] from the health care ecosystem and restore true indemnity insurance.
“Health plans are the corporate version of socialized medicine and were created by U.S. Senator Ted Kennedy decades ago to get Americans used to outsiders controlling what is allowed in the exam room,” said Flanders. “Prior authorization is a tool that health plans are legally allowed to use, and a voluntary pledge to reform the process is unlikely to yield any meaningful outcomes.”
To restore freedom in health care, Congress and the president will have to make more fundamental changes, says Blocher.
“Prior authorizations are just one symptom of a power shift in health care that imposes insurance companies into the middle of the doctor-patient relationship,” said Blocher. “Getting those companies to promise that they will change how they use prior authorizations doesn’t address all of the other barriers they erect to protect their profits despite the moral harm to patients.”
Kevin Stone ([email protected]) writes from Arlington, Texas.
