Recent polling shows that Democrats will likely flip the House, and maybe even the Senate. Democratic leaders are already plotting out their legislative agenda for the coming year. And they've rightly put health insurance reforms at the top of the priority list.
Taking on powerful insurers would allow Democrats to improve hundreds of millions of patients' lives -- especially those of the older Hispanic adults that I work with. And since many of these reform proposals already enjoy broad bipartisan support, they're politically achievable, even with the White House in Republican hands.
Senate Democrats, in particular, have pointed out that for-profit insurance companies receive hundreds of billions of dollars in subsidies and tax breaks, yet often fail to actually provide comprehensive, high-quality coverage. Instead, these companies create plans with high premiums, unreachable deductibles, and cost-sharing requirements that saddle many patients with high out-of-pocket expenses. Oftentimes, that causes patients to forgo necessary care.
A recent KFF poll found that about half of insured adults say that lowering their out-of-pocket expenses is the most important change that lawmakers could make to their health insurance. And 22% of insured adults say that eliminating prior authorization -- the insurer requirement that doctors seek their permission before prescribing certain treatments or procedures -- would be the single-most important change lawmakers could make.
About three-quarters of Americans say that insurer delays and denials are a "major problem" -- and insurers frequently use prior authorization requirements to delay and deny access to critical care. In many cases, patients end up spending weeks without the care their medical team actually believes is best -- or never receiving it at all. About a quarter of doctors even say that they've had a patient require hospitalization, suffer permanent damage, or die because of prior authorization delays.
These practices particularly harm the patients I advocate for.
Many Hispanic older adults live with chronic diseases that require consistent access to care. Hispanic Americans have some of the highest rates of chronic disease -- about 25% have high blood pressure, and over half will be diagnosed with type 2 diabetes in their lifetime. They face high rates of chronic liver disease and chronic kidney disease. And they are 1.5 times as likely to develop Alzheimer's as white Americans.
These adults already disproportionately struggle to afford health care -- and insurers' restrictions compound the problem. Research shows that some health insurers often use prior authorization to block care for seniors, forcing them to pay more out-of-pocket or go without care. About four in 10 Hispanic Americans say that a lack of good health insurance coverage is a barrier to receiving care for Alzheimer's and other dementias.
And of course, these insurance barriers don't just hurt individual older Hispanic adults -- they also harm their caregivers and communities. Family members and loved ones must manage medications and doctor's appointments in an incredibly complex insurance environment, often taking on financial and administrative burdens alongside the emotional strain of caregiving.
These challenges will only become more pressing as this population grows. Right now, there are roughly 6 million Hispanic seniors in the United States. That figure could approach 20 million by 2060.
Hispanic older adults and their caregivers should not have to navigate repeated denials, paperwork, or insurer-mandated treatment changes simply to follow doctors' recommendations.
Thankfully, Senate Democrats have already floated numerous solutions, from limiting the use of coinsurance for necessary health services, to creating maximum out-of-pocket caps, to establishing income-based deductibles. They've also contemplated imposing tighter restrictions on prior authorization, improving the appeals process for claim denials, and holding insurers accountable when they improperly deny care.
All of these potential reforms would make health care vastly more affordable for Americans.
Already, some of these insurance reforms have bipartisan buy-in -- meaning that even without control of both chambers of Congress, Democrats could help get meaningful reforms across the finish line. Patients across the country -- including millions of Hispanic seniors and their families -- are counting on them.
Dr. Yanira Cruz is the President and CEO of the National Hispanic Council on Aging.
Taking on powerful insurers would allow Democrats to improve hundreds of millions of patients' lives -- especially those of the older Hispanic adults that I work with. And since many of these reform proposals already enjoy broad bipartisan support, they're politically achievable, even with the White House in Republican hands.
Senate Democrats, in particular, have pointed out that for-profit insurance companies receive hundreds of billions of dollars in subsidies and tax breaks, yet often fail to actually provide comprehensive, high-quality coverage. Instead, these companies create plans with high premiums, unreachable deductibles, and cost-sharing requirements that saddle many patients with high out-of-pocket expenses. Oftentimes, that causes patients to forgo necessary care.
A recent KFF poll found that about half of insured adults say that lowering their out-of-pocket expenses is the most important change that lawmakers could make to their health insurance. And 22% of insured adults say that eliminating prior authorization -- the insurer requirement that doctors seek their permission before prescribing certain treatments or procedures -- would be the single-most important change lawmakers could make.
About three-quarters of Americans say that insurer delays and denials are a "major problem" -- and insurers frequently use prior authorization requirements to delay and deny access to critical care. In many cases, patients end up spending weeks without the care their medical team actually believes is best -- or never receiving it at all. About a quarter of doctors even say that they've had a patient require hospitalization, suffer permanent damage, or die because of prior authorization delays.
These practices particularly harm the patients I advocate for.
Many Hispanic older adults live with chronic diseases that require consistent access to care. Hispanic Americans have some of the highest rates of chronic disease -- about 25% have high blood pressure, and over half will be diagnosed with type 2 diabetes in their lifetime. They face high rates of chronic liver disease and chronic kidney disease. And they are 1.5 times as likely to develop Alzheimer's as white Americans.
These adults already disproportionately struggle to afford health care -- and insurers' restrictions compound the problem. Research shows that some health insurers often use prior authorization to block care for seniors, forcing them to pay more out-of-pocket or go without care. About four in 10 Hispanic Americans say that a lack of good health insurance coverage is a barrier to receiving care for Alzheimer's and other dementias.
And of course, these insurance barriers don't just hurt individual older Hispanic adults -- they also harm their caregivers and communities. Family members and loved ones must manage medications and doctor's appointments in an incredibly complex insurance environment, often taking on financial and administrative burdens alongside the emotional strain of caregiving.
These challenges will only become more pressing as this population grows. Right now, there are roughly 6 million Hispanic seniors in the United States. That figure could approach 20 million by 2060.
Hispanic older adults and their caregivers should not have to navigate repeated denials, paperwork, or insurer-mandated treatment changes simply to follow doctors' recommendations.
Thankfully, Senate Democrats have already floated numerous solutions, from limiting the use of coinsurance for necessary health services, to creating maximum out-of-pocket caps, to establishing income-based deductibles. They've also contemplated imposing tighter restrictions on prior authorization, improving the appeals process for claim denials, and holding insurers accountable when they improperly deny care.
All of these potential reforms would make health care vastly more affordable for Americans.
Already, some of these insurance reforms have bipartisan buy-in -- meaning that even without control of both chambers of Congress, Democrats could help get meaningful reforms across the finish line. Patients across the country -- including millions of Hispanic seniors and their families -- are counting on them.
Dr. Yanira Cruz is the President and CEO of the National Hispanic Council on Aging.
