News &Media

Each year, a staggering number of Americans pursue vital forms of medical care, only to discover before or after treatment that their health insurance company won’t cover the expected portion of the bill. In 2023, almost one in five insured adults reported a denied claim. Of those, 55% were forced to pay more than expected out of pocket, and another 24%–26% experienced delayed care, an inability to afford care at all, or worsened health conditions as a direct result of denied claims. 

It’s an all-too-common nightmare that can drive the most vulnerable Americans into deep debt or even death, and it’s rooted in the fact that the US healthcare system is driven by profits rather than patient care and rights. 

Just one example of this is the fact that corporate health insurers can legally make millions of dollars in strategic contributions to political campaigns. In doing so, they ensure that legislation around healthcare insurance choices, coverage, costs, and regulation results in profits for them rather than accessible or affordable high-quality care for patients. 

There are plenty of other forms of corruption in American healthcare, notably in the pharmaceutical and healthcare products industry. But given that private health insurance is the primary means by which the majority of Americans obtain access to any form of medical care, the topic of corrupt political campaign donations by insurers is one that urgently demands investigation.

Here’s what everyone should know about our for-profit healthcare system, the impacts of health insurance corruption, what you can do if you have a denied health insurance claim — and how you can help to achieve better regulation of the US government and health insurance for all Americans.

How Does the US Profit-Driven Health Insurance System Work?

The American healthcare system is unique in its reliance on private health insurance companies, which prioritize profits over patient care. Unlike in many other developed nations, where healthcare is largely funded by the government, the US system is dominated by private insurers who control access to medical services through a complex web of policies and regulations. 

These corporations make billions annually by setting premiums, deductibles, and copayments at levels that are often unaffordable for many citizens. Consequently, healthcare access is tied to one’s financial status rather than medical need. 

The Impacts of Political Contributions by Corporate Healthcare Insurers

Political contributions play a significant role in shaping US healthcare policy. Health insurance corporations contribute substantial sums to political campaigns to secure favorable legislation. Offering bipartisan support ensures that regardless of which party gains power, the interests of the insurance companies will be protected.

These contributions often result in legislation that weakens regulations on insurers, allowing them to maximize profits. For example, laws that limit the amount insurers must spend on patient care versus administrative costs (known as medical loss ratios) can be influenced or weakened, leading to higher premiums and out-of-pocket costs for patients. The lack of stringent regulation allows insurers to deny claims and reduce coverage for essential treatments, further exacerbating the financial burden on patients.

Health Insurance Corruption in the State of Michigan

Some especially telling examples of this are how healthcare companies in Michigan influence politics. In 2017, health insurance companies in Michigan were major donors to political campaigns, contributing significantly to both parties. This financial influence was evident when lawmakers, pressured by these contributions, moved to give insurers more control over mental health services, potentially compromising the quality of healthcare in Michigan.

Governor Whitmer's recent efforts to secure commitments from insurers to protect coverage for no-cost preventive healthcare highlight the ongoing battle between state efforts to protect consumers and the influence of powerful insurance lobbyists. These dynamics illustrate how insurers leverage their financial clout to shape state policies and make profits, often at the expense of patient care.

What You Can Do If Your Insurer Denies a Healthcare Claim

If your health insurance claim is denied, it’s crucial to take action promptly. Here are some steps you can follow to rectify the situation:

1. Review the denial letter. Make sure you understand the precise reason for the denial and gather any necessary documentation.

1. Contact your insurance company. Speak with a representative to clarify the denial and ask for reconsideration.

1. File an appeal. Submit a formal appeal to your insurance company. Include all relevant information and documentation.

1. Seek an external review. If your appeal is denied, request an external review by an independent third party, such as a health insurance claim denial attorney. 

If you can’t afford an attorney, seek out a healthcare-related nonprofit near you to find out if they offer legal claims services at low or no cost. In Michigan, Care Over Cost provides resources and support for individuals navigating denied claims, offering guidance on how to effectively appeal insurance decisions. 

This program is administered by social justice nonprofit Michigan United, which is focused on achieving healthcare bill relief and decreasing the power of the private insurance industry.

1. Contact your state insurance department. If none of the above strategies work, file a complaint with your state’s insurance department to receive further assistance.

How You Can Help Stop Health Insurance Corruption

Stopping health insurance corruption requires a collective effort, especially given that corporate health insurers are regulated at the state rather than the federal level. Here’s how you can fight for fair health claim coverage in your state:

1. Stay informed. Educate yourself about how political contributions influence healthcare policies.

1. Advocate for change. Support legislation that seeks to increase transparency in and regulation of the health insurance industry. 

1. Vote wisely. Use the power of your ballot to elect representatives who prioritize healthcare reform and are committed to reducing the influence of corporate money in politics.

1. Support advocacy groups. Join or donate to organizations that fight for patient rights and work towards healthcare reform. For example, Michigan United works for fair insurance claim coverage and equitable access to healthcare as a whole.

1. Raise awareness. Use your social media and community platforms to highlight issues related to health insurance corruption and mobilize others to take action. You can make it easy for them and increase the likelihood of success by sending or publishing links to relevant campaigns, initiatives, and petitions.

By taking these steps, you can help create a more equitable healthcare system where access to medical care is determined by need rather than profit, and in which all Americans can get the care they need — not just those with wealth, power, and privilege.

Get Fair Health Insurance Coverage With Michigan United

Michigan United is a broad, statewide coalition working to reform our broken healthcare and immigration systems, protect our environment, end mass incarceration, and make essential services accessible to all. We develop leadership tools for our members so they can eradicate the root causes of racial and economic injustice.

At Michigan United, we are steadfast in our belief that every person deserves access to quality healthcare, unencumbered by financial barriers or discriminatory practices. Health is a fundamental human right, not a privilege reserved for the fortunate few.

Is your insurance company refusing to pay for the care you need? Want to end this problem in Michigan for good? In addition to reaching out to Care Over Cost, you can help others by signing these petitions to demand care and joining our fight with a group near you.

Did you know that almost all of the largest corporate contributors to Michigan political funds — including those that impact healthcare legislation — are monopoly corporations, many of which are hoping to secure profitable government contracts? It doesn’t have to be this way. Join us in urging state lawmakers to sign the Taking Back Our Power Pledge, which advocates for a Michigan state law that would prohibit regulated monopoly corporations and government contract-seeking corporations from making state or local political contributions.

Contact us today to get started!