The Center for American Principles submitted comments to the Senate Finance Committee in response to its Request for Information, “Health Coverage That Works For Everyone,” urging lawmakers to pursue targeted reforms addressing health insurer transparency, Medical Loss Ratio (MLR) rules, and prior authorization.
CAP argues that existing MLR requirements have not kept pace with an increasingly vertically integrated health insurance market. The letter raises concerns that payments between insurers and affiliated physician practices, pharmacy benefit managers, pharmacies, and other healthcare businesses can be counted as medical spending even when some of those dollars ultimately remain within the same corporate organization
CAP recommends greater transparency through standardized MLR reporting, disclosure of payments to insurer-owned affiliates, routine audits, and tighter standards governing what insurers may classify as quality-improvement spending.
The letter also calls for enforceable reforms to prior authorization, including firm deadlines for coverage decisions, reviews by appropriately qualified clinicians, clear explanations when care is denied, and consequences for repeated delays or denials of care later determined to be necessary.
CAP urges Congress to make insurer transparency and accountability a priority, arguing that modernizing MLR rules and reforming prior authorization can better protect patients and ensure premium and taxpayer dollars are directed toward care without expanding federal control over health coverage.