THIS TIME ON CODE WACK!
How are big insurance companies dodging the very rules meant to protect patients — and turning our health care system into a profit machine for Wall Street? What can we the people do to stop it?
Join us as we dive into the dark side of corporate loopholes, for-profit health care, and policy failure with Rachel Madley, Director of Policy and Advocacy at the Center for Health and Democracy. A former FDA staffer and health policy advisor to Congresswoman Pramila Jayapal, Rachel played a key role in crafting and reintroducing the House Medicare for All bill in 2023. With a PhD in Microbiology and Immunology from Columbia University, she brings both scientific rigor and firsthand policy experience to this eye-opening conversation.
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
As Director of Policy and Advocacy at the Center for Health and Democracy, what are you focused on these days?
“… these days I am focusing mainly on what Big Insurance is doing to get around the rules and regulations put in place. Because there are a lot of things that Congress has passed to make sure that health insurance companies provide us with the care that we’re paying for. But unfortunately, they have teams of lawyers who have found loopholes in almost every one of those regulations.
“For example, there is something called the medical loss ratio. Essentially, it just requires that health insurance companies spend 80 to 85% of the money that we pay them on our healthcare, which makes sense, right?
We have to be getting the care that we’re paying for.
“Unfortunately, companies have found a way to make it look like on paper they’re spending that money on our healthcare, but really they’re moving the money around..” – Rachel Madley
Has anyone looked into these loopholes before?
“I don’t think anyone has done this before …The system is so complex that one of the reasons that we’re able to understand what insurance companies are doing is because our founder [Wendell Potter] was an ex-insurance executive…”
“…We also work with other ex-insurance executives who have that inside knowledge to know what’s happening, whether it’s things that they personally experienced or knowing what words to look for in shareholder meetings or in things like, financial reports or even forms that are filed with the [Securities Exchange Commission] and [the Centers for Medicare & Medicaid Services].
“So knowing what happens on the inside is the only way that we can understand what they’re doing.” – Rachel Madley
At the Center for Health and Democracy, you focus on exposing how corporate power influences health policy. Can you share some of the most concerning ways you’ve seen this dynamic play out recently – and how it impacts everyday people’s access to care?
“I think one of the most concerning ways was the choice by Congressional Republicans to make cuts to Medicaid that will throw millions off their health insurance to find savings rather than reforming Medicare Advantage abuses and finding savings there, which would not throw anyone off their care.
“And I think the reason that was so concerning is because if you look at the effects from both policies — either cuts to Medicaid or reforms to Medicare Advantage, there is such a difference in the effect it will have on people and unfortunately the Republican members of Congress chose the policy option that is going to affect millions of people and will be, potentially a death sentence for a lot of people who rely on Medicaid.
“I think that is really concerning because it shows the imbalance of power between corporate influence and the people and right now decisions are being made based on what corporate health insurers want and not based on what the people want. And that’s another reason why I think it’s so important for us to find common ground across parties for voters because the people should have more power and influence than corporations do, but we’re not seeing that play out on Capitol Hill right now.” – Rachel Madley
Helpful Links
Center for Health and Democracy
The Dirty Trick Health Insurers Are Playing That You Don’t Know About, HEALTH CARE un-covered
Navigating the Maze: A Look at Health Insurance Complexities and Consumer Protections, KFF
Fact Sheet: One Big Beautiful Bill Act Would Significantly Reduce Availability of Coverage in the Health Insurance Marketplaces, American Hospital Association
Preliminary Estimates Suggest Devastating Health Care Impacts from GOP Plans, The Century Foundation
Episode Transcript
Read the full episode transcript.
Biography: Rachel Madley, PhD
Rachel Madley, PhD is the Director of Policy and Advocacy at the Center for Health and Democracy. She previously worked as health policy advisor to Congresswoman Pramila Jayapal and in the legislative affairs office at the U.S. Food and Drug Administration.
Rachel received her PhD in Microbiology and Immunology from Columbia University where she was also a member of the executive board of Students for a National Health Program and Physicians for a National Health Program.
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