In the time since a former Hawaiʻi resident was accused of fatally shooting UnitedHealthcare CEO Brian Thompson on Dec. 4, there's been much speculation about his motive. However, the insurance company said that Luigi Mangione was never a client.
"It's really tragic that Brian Thompson was murdered, and nobody is going to defend that," said Dr. Jack Lewin, head of the State Health Planning and Development Agency. "The other side of this, though, is the amazing public reaction, where in social media, the vast majority of respondents are siding with him. They're paying his legal fees, and it just expresses this anger that has been rising in America about corporate America taking over our health care in a way that people are worried isn't good."
Lewin said that UnitedHealthcare has a local presence in Medicaid and Medicare Advantage plans, but that its commercial portfolio in Hawaiʻi is small. He said Hawaiʻi is lucky that most of the insurance companies in the state aren't run by shareholders. UnitedHealthcare, on the other hand, is a for-profit company owned by shareholders.
"UnitedHealthcare is the biggest company, so it's kind of the biggest target of public angst that is growing about insurance companies," Lewin said.
One of the practices associated with medical insurance is prior authorization, the process by which insurance companies review prescribed treatments and decide if the care is needed. If the insurance company concludes the care is unnecessary, it will deny payment — leaving the patient to pay out of pocket.
"Some of my colleagues in medicine, my fellow doctors, think that insurance companies are starting to practice medicine by making these decisions, because the frequency of them has increased to the point where most doctors have to hire a staff person at an expense to just manage the prior authorizations, because as many as 25% of the patients that they see have to go through a prior authorization," he said.
His agency plans to propose legislation related to prior authorization in this upcoming session. One of the measures would require insurance companies to provide data on their respective approval processes to the state agency. A second measure would gather health care providers and insurance companies to work toward standards for prior authorization.
He acknowledged that the variable cost of services from one medical center to the next is also part of the discussion.
"If the price is down low, the insurance company doesn't care, and if the price is high, then they're going to add more scrutiny to it," Lewin said. "There are dueling interests and priorities here at stake. I prefer not to vilify the insurance industry completely, because I think they're just part of the U.S. economy, the way we do things. On the other hand, I think a lot of improvement can be made, and I think it will be a benefit to the insurance company, as well as to the doctor and to the patient."
Lewin said he wants Hawaiʻi to become the model for a better health care industry in the future.
"We've done a lot of innovating here, so let's continue to do that now, because health care is getting more expensive each year, and we kind of wonder, how do we pay for all this?" Lewin told HPR. "We really have to start thinking clearly and out of the box."
This interview aired on The Conversation on Dec. 16, 2024. The Conversation airs weekdays at 11 a.m. on HPR-1.
