By Wesley Brown, Arkansas Black Vitality Publisher

June 30, 2025 – As the U.S. Senate considers approving the budget reconciliation process for President Trump’s “Big Beautiful Bill,” the nation’s leading healthcare providers warn that the nearly 1,000-page legislation to make many of the tax breaks from Trump’s first term permanent could cause millions of Americans to lose Medicaid coverage.

AHIP, the nation’s largest health insurance trade association, provides health care coverage and services more than 200 million Americans through some of the nation’s largest health care insurers, including Blue Cross Blue Shield Association, Cigna, Elevance Health, GuideWell, Humana, Kaiser Permanente and UnitedHealthcare.

“Americans are looking for stability and certainty with their health care, yet the budget proposal before the Senate will disrupt the health coverage and affordable access to care millions of Americans rely on in Medicaid and the individual market,” AHIP said in a June 28 statement. Enactment of these policies combined with potential expiration of health care tax credits later this year would mean millions of people losing Medicaid coverage would find a disrupted individual market with less competition, diminished.”

The AHIP concerns are being raised just as the U.S. Senate frantically tries to pass President Trump’s massive tax cut, which would give the country’s “one percenters” an average tax cut of over $60,000 in 2025, while households in the bottom 60 percent would see an average cut of less than $500, according to the Tax Policy Center (TPC).

The original reconciliation bill approved by the House of Representatives last month—titled the One Big Beautiful Bill Act of 2025 (OBBBA) on May 21—would increase primary deficits by $2.4 trillion over the next decade, adding $3.0 trillion to the national debt, including interest. If its temporary measures are extended without offsets, it would raise the national debt by $5.0 trillion, including interest, according to estimates by the Committee for a Responsible Federal Budget.

UnitedHealthcare killing puts prior authorization in the spotlight

As America waits for the fate of President Trump legacy-leading legislation, AHIP and its members are also facing political and public pressure of their own. Following the murder of UnitedHealthcare CEO Brian Thompson in December, a group of shareholders sued the healthcare giant for allegedly hiding a corporate strategy to deny medical care and obfuscating how the killing impacted the company’s bottom line.

And as pressure from health care advocates, hospitals, consumer groups and lawmakers ramp up on the industry’s efforts to deny medical care to millions, AHIP, Blue Cross and Blue Shield and other health insurance providers vowed recently to revamp the approval process for medical care claims.

In a news release from the Blue Cross Blue Shield Association and AHIP, the health insurance cartel committed to “streamline, simplify and reduce prior authorization,” which requires health care professionals to obtain advance approval from a health plan before care is delivered to the patient to qualify for paid coverage. 

“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike,” said AHIP President and CEO Mike Tuffin, adding, “Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system.”

The group said these commitments are being carried out across insurance markets, including for those with Commercial coverage, Medicare Advantage, and Medicaid managed care, in line with state and federal regulations, and will benefit 257 million Americans.

For patients, these commitments will result in faster, more direct access to appropriate treatments and medical services with fewer challenges navigating the health system. For providers, these commitments will streamline prior authorization workflows, allowing for a more efficient and transparent process overall, while ensuring evidence-based care for their patients.

“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike. Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system,” said AHIP President and CEO Mike Tuffin.

“These measurable commitments – addressing improvements like timeliness, scope and streamlining – mark a meaningful step forward in our work together to create a better system of health,” said Kim Keck, President and CEO, Blue Cross Blue Shield Association. “This is an important foundation to address bigger problems together, at a time when technology and interoperability can deliver real improvements to patient experience.”

Among many things, the six-point commitment promises to standardize online prior authorization, reduce the scope of claims before approval, ensure continuity of care when an individual plan changes, improve communication and transparency regarding claim determinations, expand real-time responses, and guarantee review of non-approved requests.

Prior authorization emerged as a significant topic in the national health care discussion following the killing of former UnitedHealthcare CEO Brian Thompson in late 2024. Since then, there has been widespread outrage against UnitedHealthcare and other insurance companies that allegedly go to extra lengths to deny treatment.

That national frustration and growing support for Luigi Mangione, the 26-year-old Maryland suspect accused of killing Thompson, caused UnitedHealthcare to announce in March that it planned to reduce prior authorization requirements by about 10% in 2025.

“Private-sector collaboration and solution-oriented commitments are critical to improve policy and tackle challenges. With membership spanning the entire healthcare continuum, we appreciate the need to balance appropriate medical management with timely access to care. This announcement from health insurance plans is an important step toward improving the prior authorization process,” said Maria Ghazal, President and CEO of the Healthcare Leadership Council. “We must seize this opportunity to turn these initiatives into real, sustained progress for patients.”

“The National Health Council (NHC) welcomes the commitment of health plans to reform prior authorization practices as an encouraging step toward better access to care. For years, the NHC has called for changes that make the system work easier and better for people living with chronic diseases and disabilities,” said Randall Rutta, NHC’s Chief Executive Officer. “The NHC is a ready partner to AHIP, BCBSA and health plans making these commitments to promote meaningful action that reduces administrative burden, increases transparency and centers on the needs of patients.”

“We are encouraged by this collective commitment to reform prior authorization practices. Physicians have long advocated for reforms that help ensure that patients receive timely, medically necessary care and reduce administrative burden – including the elimination of unnecessary prior authorizations,” said Shawn Martin, CEO of the American Academy of Family Physicians. “While this commitment is a step in the right direction, we will ultimately measure its impact by real changes in the day-to-day experiences of patients and the physicians who care for them. We look forward to collaborating with payers to ensure these efforts lead to meaningful and lasting improvements in patient care.”

According to AHIP, the health insurer’s progress will be tracked and reported. A full list of participating health plans and additional information are available at: www.ahip.org/supportingpatients and https://www.bcbs.com/ImprovingPA.