[Congressional Record Volume 172, Number 96 (Monday, June 8, 2026)]
[House]
[Page H3915]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          HEALTH INSURANCE COMPANY MEDICARE ADVANTAGE DENIALS

  (Mr. Murphy of North Carolina was recognized to address the House for 
5 minutes.)
  Mr. MURPHY. Mr. Speaker, I rise today to continue to shed light on 
the egregious practices of our health insurance industry companies that 
continue to deny patients care and rip off the American taxpayers.
  I have been practicing medicine now for 35 years and have dedicated 
my life to serving others, primarily those in rural and underserved 
areas. American medicine is sick. American medicine is unaffordable.
  A few months ago, the House Ways and Means Committee hosted 
representatives from multiple insurance companies to deal with 
healthcare affordability. During that time, I exposed the 
unconscionable practices of these megacorporations that squeeze every 
penny out of patients and physicians for their own profit.
  Today, I want to talk about the bad actors in Medicare Advantage, a 
program that seeks to prey upon the elderly and those who have health 
insurance issues as they get older, that rely on prior authorizations 
as a way to deny care.
  These denials have been up in recent years, as have been, amazingly 
enough, insurance company profits. They have created barriers to 
lifesaving care for patients.
  In fact, in 2024, Medicare Advantage insurers denied over 4 million 
prior authorization requests. Yet, when appealed, over 80 percent of 
those were overturned. This was only after patients and caregivers were 
forced to fight for the care that they deserve. Sadly, many give up, 
and they don't receive the care that they need and the care that they 
have paid for.
  I am far from the only physician ringing the bell on this travesty. 
Recent surveys show that 93 percent of doctors say that prior 
authorization leads to care delays, and 82 percent say that it 
sometimes causes patient harm. Nearly one in three state that delays 
have contributed to a serious adverse safety event.
  The current state of prior authorization allows insurance companies 
to deny care and pad their profits.
  I commend the Trump administration for bringing insurance companies 
to the table and forcing them to improve their process. Sadly enough, I 
don't believe a word that these insurance companies say because they 
are ever increasingly putting profits above patients.
  I understand that there are bad actors and those who overbill the 
system. I truly do. They overorder to drive up costs. The response 
cannot be a regime that continues delays and denies care for patients 
who deserve to be healthy.
  Congress must be bold in its action to deliver meaningful and lasting 
solutions to make healthcare work for all Americans.
  I am proud to have introduced the Medicare Advantage Improvement Act 
with my friend and colleague, Dr.   John Joyce. As co-chairs of the GOP 
Doctors Caucus, our unique experience as physician-legislators gives us 
perspective on how the healthcare system delivers and finances care.
  MAIA streamlines Medicare Advantage prior authorization by enabling 
real-time approvals for routine care, setting up clear decision 
guidelines and preventing repetitive reauthorization denials, denials, 
denials. It also strengthens network adequacy and access centers so 
that seniors can obtain the full spectrum of medically necessary care 
when they need it.
  Healthcare is expensive. We are living longer because of wonderful 
innovations in healthcare. Yet, sadly enough, vertical integration and 
the middlemen are destroying the American healthcare system. We don't 
need to be padding the profits of middlemen, be they insurance 
companies, be they PBMs, or be they any individuals in the middle who 
are siphoning off profits away from patients and away from those who 
care for patients.
  We need to get back to a system that is streamlined, and we need to 
stop paying those who deny patient care.

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