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  • Medicare Advantage Insurers Deny Prior Authorization Requests for Post Acute Care at Substantially Higher Rates Than the Overall Denial Rate

    Policy Watch

    Two recent reports find that Medicare Advantage organizations deny prior authorization requests for long-term care hospital, inpatient rehabilitation hospital, and skilled nursing facility stays at higher rates than requests overall. When these decisions are appealed, they are frequently overturned, particularly for skilled nursing facility stays. This may cause delays for Medicare beneficiaries who are particularly vulnerable or have high care needs.

  • A One-Pager on What’s Wrong with U.S. Health Care

    From Drew Altman

    Asked for a one-pager on what's wrong with the U.S. health system, Dr. Drew Altman, Founding President and CEO, explains the top issues in this piece, published today as his latest column. Altman explains, "We have neither a competitive health care system nor a regulated one—we have a fragmented, micromanaged health system that fails to control costs and makes both patients and health professionals more miserable than they should be..."

  • Are Health Insurance Companies the Reason for Our Health System’s Ills? 

    Perspective

    In this JAMA Health Forum column, KFF's Larry Levitt examines the criticism that health insurance companies are facing from political leaders, and explores the industry's role in both causing and addressing some of the health systems' biggest problems, including rising costs and prior authorization review.

  • The New Ideas Conundrum in Health Policy

    From Drew Altman

    In a new column, President and CEO Dr. Drew Altman writes about the "conundrum of health policy ideas" facing Democrats searching for new proposals because of competing, and complex, priorities: rebuilding Medicaid and the ACA after trillion-dollar cuts, reconstructing federal health agencies, and tackling underlying health care costs, when candidates want simple ideas they can campaign on and voters want their costs to come down.

  • Claims Denials and Appeals in ACA Marketplace Plans in 2024

    Issue Brief

    This brief analyzes federal transparency data published by CMS on claims denials and appeals for Marketplace plan offered on HealthCare.gov in 2024, and finds insurers denied 19% of in-network claims. Consumers rarely appeal denied claims.

  • Examining the Potential Impact of Medicare’s New WISeR Model

    Issue Brief

    On January 1, 2026, the Center for Medicare & Medicaid Innovation (CMMI) launched the Wasteful and Inappropriate Service Reduction (WISeR) Model that establishes new prior authorization requirements in traditional Medicare. This analysis explores the potential impact of the WISeR model by examining recent spending and utilization trends in traditional Medicare for services selected for prior authorization requirements in the six model states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington).