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KFF designs, conducts and analyzes original public opinion and survey research on Americans’ attitudes, knowledge, and experiences with the health care system to help amplify the public’s voice in major national debates.
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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..."
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.
Certain insurers must now publicly report specific prior authorization metrics, but the new data offer limited insight, providing no information on what types of services are being approved and denied or why as well as no data on prescription drugs.
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.
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.
Our updated explainer provides an overview of comprehensive managed care, the most common way states deliver Medicaid services to enrollees.
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).
New KFF polling explores the challenges beyond costs that people with insurance face in navigating the health care system. People cite prior authorization review as their top problem by a wide margin, with a third (32%) saying prior authorization requirements are a “major burden.” That’s more than say the same about understanding their bill or what they owe (23% say it is a major burden), getting appointments when they need them (20%), or finding providers…
KFF's health tracking poll finds that beyond costs, insured adults say prior authorization is their biggest challenges when accessing care. About seven in ten (69%) insured adults say prior authorizations are burdensome, and a third (34%) choose prior authorizations as their single biggest health care burden.
Nearly 53 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2024, of which 4.1 million (7.7%) were denied. Just 11.5% of denied requests were appealed, though 80.7% of appeals overturned the initial denial in Medicare Advantage. Substantially fewer prior authorization requests were made in traditional Medicare, reflecting the small number of services subject to prior authorization requirements.
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