Prior Authorization: America's Top Health Care Headache According to New KFF Poll
Prior Authorization: America's Top Health Care Headache According to New KFF Poll
Imagine needing urgent cancer treatment, only to wait weeks for your insurer's approval. A recent KFF Health Tracking Poll reveals that prior authorization - the insurer gatekeeping process for tests, drugs, and procedures - tops the list of burdens for insured Americans navigating health care.[4][2] This frustration hits patients, doctors, and families hard, fueling calls for urgent reform.[3]
Background/Context
Prior authorization requires doctors to get insurer okay before providing certain care, meant to control costs but often delaying treatment.[1] Practices exploded in Medicare Advantage (MA), with insurers handling nearly 53 million requests in 2024, up from prior years.[1][5]
KFF polls trace this issue amid rising complaints. A July 2025 survey of 1,283 U.S. adults found broad discontent just after insurers pledged reforms.[2] Biden-era rules starting 2023 limited PA to medical necessity checks, with more transparency by 2026.[1] Yet, Trump administration shifts in 2025 dropped some equity mandates, keeping tensions high.[1][6]
Industry trends show PA varying wildly: Kaiser plans averaged 0.6 requests per enrollee, while Elevance and Centene hit 3.0.[1] Pledges from AHIP members like UnitedHealthcare and CVS Aetna followed HHS meetings, but skepticism lingers.[3][7]
Main Analysis
The KFF poll cuts deep: one in three insured adults (33%) call prior authorization a major burden, with 37% saying minor - totaling 69% affected.[4] This outranks understanding bills (60%), booking appointments (60%), or finding in-network doctors (53%).[4]
Across parties, it's the top gripe. Democrats, independents, and Republicans all rank it highest, as do Medicaid users (28% cite provider access second).[4] In a related poll, 73% labeled insurance delays/denials a major problem.[7]
Denials sting: CMS data shows MA plans denying 22.9%-28.8% of requests from 2021-2024.[1] A July 8-14, 2025, KFF survey (margin of error ±3%) confirmed three-quarters see PA as problematic, post-AHIP pledge.[2][3]
Insurers pledged in June 2025 to streamline: fewer PAs, faster reviews, clearer denials.[3][6] But only 29% of Democrats and 18% of MAGA Republicans expect meaningful change.[2] AMA pushes "true peer" reviews, especially for oncology where reps lag guidelines.[3]
| Insurer Group | PA Requests per Enrollee (2024) | Denial Rate Example |
|---|---|---|
| Kaiser | 0.6 | Lower overall[1] |
| Elevance/Centene | 3.0 | Higher volume[1] |
| CMS-reviewed | N/A | 22.9% denied[1] |
Real-World Impact
Patients suffer most. Delays block timely care - like chemotherapy - worsening outcomes for cancer or chronic illness sufferers.[6] Doctors waste hours on paperwork, with one AMA leader noting past 2018 promises flopped.[6]
Families feel it financially and emotionally. 67% of independents doubt insurer follow-through, eroding trust.[2] Medicaid enrollees face extra hurdles, despite high PA use.[7]
Reforms could save lives: 2026 rules mandate electronic processing and 72-hour urgent responses in MA/Medicaid.[6] Bipartisan bills seek peer reviews, but without teeth, burdens persist.[3] Employers report PA headaches too, per KFF's 2025 survey on drugs like GLP-1s.[8]
Take Sarah, a fictional composite from reports: her MA plan denied MRI for back pain, delaying surgery by months.[4] Real stories like hers drive 71% Democrats viewing delays as major issues.[2]
Different Perspectives
Insurers defend PA as cost-control, preventing unnecessary care amid $4 trillion U.S. health spending.[1] AHIP's pledge promises data tracking on progress sites.[3]
Doctors and patients counter it's bureaucratic overkill. AMA's Bobby Mukkamala demands "substantive actions," citing oncology denials by underqualified staff.[3][6] KFF notes few trust insurers: only 18-29% across parties.[2]
Policymakers split: Trump HHS pushed voluntary fixes over mandates.[6][7] Bipartisan Congress eyes MA curbs, while states vary on Medicaid PA.[7]
Key Takeaways
- Prior authorization burdens 69% of insured adults most, per KFF, outpacing costs or access woes - reform can't wait.[4]
- Nearly 53 million MA requests in 2024 show scale; denials hit 23-29%, delaying critical care.[1][5]
- Insurer pledges exist, but polls show low faith (under 30% expect change) - watch 2026 rules for impact.[2][6]
- Patients with chronic needs suffer worst; bipartisan bills could enforce peer reviews.[3]
- Streamlining PA boosts trust, speeds care - key for fixing U.S. health navigation.[7]