High health care costs continue to plague residents of the Keystone State. A survey conducted last year found that 57 percent of Pennsylvanians experienced at least one health care affordability burden in 2023 and nearly one-third incurred medical debt, depleted savings, or sacrificed basic needs due to their medical bills. 

Per capita health care spending in Pennsylvania has grown nearly 27 percent since the first year of full implementation of the Affordable Care Act. Coincidentally, one of the major factors contributing to this affordability crisis has been the high cost of health insurance. Since 2013, the average family premium has increased by 47 percent nationwide and Pennsylvania has not been immune from this trend. 

Recent news that health insurers are seeking to raise in-state premium rates nearly eight percent on average for 2025 illustrates the point. Some may try to attribute this to the high inflationary environment we have been confronted with over the last few years, but with inflation projected to hover around three percent for 2024, it appears that something else is at play.

As patients, hospitals, and health care workers struggle to navigate this challenging environment, health insurance companies have been raking in record revenues and the executives that run them have enjoyed huge paydays. In fact, revenues for the seven largest private health insurers have more than tripled over the last decade equating to an increase of more than $1 trillion. Compensation for the CEOs of health insurers has increased correspondingly as well with this growth, totaling nearly $123 million in 2023.

As a strong supporter of free markets, I generally do not use such figures as a point of criticism. Under most circumstances, healthy competition will direct resources where they would naturally flow. Unfortunately, the Affordable Care Act disrupted this balance by instituting a series of requirements and coverage mandates that pushed smaller health insurers out of the market. The result of this imbalance left but a few large insurers in control and, in effect, created an oligopoly. 

Today, the combined market share of the top three health insurers in Pennsylvania is around 79 percent. Concentrating so much power in such few hands has distorted the health care ecosystem and presented patients and providers with many of the problems these companies were created to prevent. Those who are sick are afraid to seek the medical care they need, fearing the financial liability of such treatments. The places where they receive medical care are oftentimes grappling with reimbursement rates that do not even cover the cost of care, presenting providers with the increasingly difficult task of balancing quality, comprehensive care for all patients while maintaining cost-effective and efficient operations. 

The marked increase in prior authorization requirements and coverage denials of late illustrates this point. According to an industry study, nearly 50 percent of providers saw an overall increase in their denial rates compared to 2022. Requirements for prior authorization have delayed patient care or have led to patients abandoning a recommended course of treatment altogether. Such tactics can often come at great expense to those seeking care, who can be faced with surprise medical bills as well as hospitals and other providers who can be left holding the bag if an insurer refuses and a patient is unable to pay.

While providers of all stripes have been impacted by these realities, rural providers have been particularly impacted. The result has been a rural health care epidemic that has left places like Snow Shoe Township without a federally qualified health care center or even a pharmacy. Work groups such as Penn State Health are using mobile health care clinics and other outreach programs to help bridge this gap. While an admirable effort on their part, things never should have come to this.

With more than five percent of residents in Pennsylvania lacking health insurance and the percentage of children without coverage in the state growing at a concerning rate, it is clear the time has come for a paradigm shift. Health insurers must recognize these realities and take steps to self-correct for the problems that have developed. Otherwise, and as a last resort, lawmakers and regulators may be forced to step in and fix this untenable status quo.

Becky Corbin is a former member of the Pennsylvania House of Representatives. During her time in office, she served on the Health Committee.