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-Editorial
The recent killing of UnitedHealthcare CEO Brian Thompson in New York has sparked national outrage, but it has also highlighted long-standing issues within the healthcare industry. While many decry Thompson’s death, public sentiment has turned toward the role of insurers like UnitedHealth in driving up healthcare costs and denying care to those who need it the most.
A recent investigation by ProPublica revealed that insurers are increasingly using artificial intelligence (AI) to deny millions of claims. Critics argue that this use of AI, which often relies on biased data, is disproportionately affecting marginalized communities and leaving many without essential care. Millions of claims are being rejected without a doctor ever reviewing a patient’s file.
The impact of AI on healthcare and the growing dissatisfaction among consumers will be central topics in upcoming panel discussions. Healthcare experts and consumer advocates will address the surge in claims denials, the role of AI in these decisions, and the increasing frustration felt by Americans struggling to access care.
Dr. Katherine Hempstead, senior policy officer at the Robert Wood Johnson Foundation, recently spoke about the complexities of the relationship between insurance companies and policyholders. “Insurance has always had a fraught relationship with customers,” Dr. Hempstead explained, noting the inherent tension between insurers, who serve as gatekeepers to services, and the consumers they serve. “This dynamic is especially tense in health insurance, where decisions impact people’s health and well-being,” she said.
One of the primary sources of frustration is the inconsistent coverage policies that vary by state, employer, and insurer. “You might live in one state and have access to a medication, but in a neighboring state, it might not be covered,” Dr. Hempstead said, pointing to the patchwork nature of insurance coverage as a significant contributor to consumer dissatisfaction.
As more people gain insurance coverage, particularly through programs like the Affordable Care Act (ACA) and Medicare Advantage, they are exposed to the challenges of managed care. “More people are insured, which is a good thing, but it also introduces a new set of challenges,” Dr. Hempstead noted, emphasizing the complicated and often frustrating processes of claims and prior authorization.
The controversy around the coverage of innovative treatments, such as GLP-1 weight-loss medications, further exacerbates consumer anger. For instance, Blue Cross Blue Shield of Michigan recently decided to stop covering certain weight-loss drugs, prompting outrage among policyholders. Dr. Hempstead described this as another example of the “incomprehensible patchwork” that defines much of the U.S. health insurance system.
Dr. Hempstead’s insights align with broader frustrations about healthcare, which are compounded by the administrative hurdles many patients face. Dr. Miranda Yaver, Assistant Professor of Health Policy and Management at the University of Pittsburgh, is set to publish a book titled Coverage Denied: How Health Insurers Drive Inequality in the United States in Spring 2026. Her research, based on nationwide surveys and interviews with patients and healthcare providers, shows that about 36% of people have experienced at least one coverage denial, with 60% of those facing multiple denials.
Dr. Yaver highlights that the administrative burden of denied claims disproportionately affects low-income and marginalized groups, especially those with lower health literacy. “Insurance documents are written at an 11th or 12th-grade level, while most Americans read at an eighth-grade level,” she explained. This discrepancy, along with a complicated system of prior authorizations and step therapy, leads to unnecessary delays and denials of essential care.
As Americans continue to struggle with a system that prioritizes cost-cutting over patient care, Dr. Yaver and other experts advocate for a rethinking of the way health insurance operates in the U.S. Dr. Yaver points to the overuse of utilization management tools, such as step therapy, which force patients to try cheaper medications before receiving the ones their doctors recommend. “This can lead to significant health consequences,” she warned.
In response to concerns over the role of AI in healthcare, California State Senator Josh Becker has introduced SB 1120: The Physicians Make Decisions Act. The bill seeks to limit the influence of AI in medical decision-making, particularly in health insurance processes like claims and prior authorization requests. Becker emphasized the importance of human expertise in healthcare decisions, noting that AI should not replace the nuanced judgments that doctors make in evaluating a patient’s needs.
The bill, which follows a troubling class action lawsuit against Cigna for using AI to deny Medicare claims without reviewing patient files, is part of a broader effort to ensure that human oversight remains central to the decision-making process. Senator Becker hopes the legislation will serve as a model for other states and inspire a national conversation about the role of AI in healthcare.
“We need a healthcare system that puts patients first, not profits,” Senator Becker concluded.
