Breaking Up Big Medicine: The Prior Authorization Crisis

What happens when the companies that profit from denying care also decide what care you get? Nurse Rosa sits down with Hannah Garden-Monheit and Emma Freer, senior fellows at the American Economic Liberties Project and leaders of the Break Up Big Medicine Coalition, to talk about their report on prior authorization. Hannah shares the personal story behind her work: her father's cancer, his amputation, and the prior auth denials that followed. Emma explains the moral injury clinicians feel when paperwork pulls them away from the bedside. Together they walk through the numbers, the policy fixes, and what nurses, clinicians, and patients can do right now about a system that too often works against the people it's supposed to serve. Timestamps 0:00 Welcome and guest introductions 1:12 Hannah's personal story: her father's cancer, amputation, and United Healthcare's prior auth denials 2:26 The Kafkaesque bureaucracy: "This is unreasonable, but I don't know how to fix it" 3:17 The inherent conflict of interest: insurers save money by denying care 3:37 Nurse Rosa on preventable disability and the economic cost of denied care 3:48 Emma on moral injury among healthcare professionals pulled away from the bedside 5:16 Heartbreaking stories: a cancer patient missing chemo infusions, migraine medication abruptly denied 5:18 Collecting patient stories at earful.us/c/prior-auth 6:19 The $32 billion annual paperwork cost, and why insurance-funded studies ignore it 8:14 What the American Economic Liberties Project does across all industries 9:30 Prior authorization as one symptom of a deeper disease in healthcare 10:00 Nurse Rosa on the moral injury of knowing treatment exists but being blocked from delivering it 10:49 Prior auth paperwork consumes the equivalent of 99,290 full-time physicians, more than the entire clinician shortage 12:29 What you can do: call your representatives, share your story, advocate for reform 14:05 Nurse Rosa on the reality of advocacy: it's on your own time and your own dime 15:31 The Break Up Big Medicine Coalition: 27 member organizations and growing (join at breakupbigmedicine.com) 16:26 The bipartisan Break Up Big Medicine Act (Sens. Warren and Hawley) and what it would do 17:09 Does this work extend to food and agriculture? Similar monopolist playbooks across industries 19:21 The $1 billion question: Emma's answer is to ban prior authorization and free patients and clinicians 20:48 Hannah's answer: invest in antitrust and consumer protection enforcement of existing laws 22:55 Don't miss the report: Emma recommends Hannah's personal foreword, and Hannah leaves us with a killer stat 24:04 Medicare Advantage vs. Traditional Medicare: 50 million vs. 600,000 prior auth determinations, and Medicare Advantage costs 22% more per patient 25:48 How to share your story at earful.us/c/prior-auth (open indefinitely, and you control your privacy) 26:42 How to reach Hannah and Emma: breakupbigmedicine.com 27:23 Closing, like and subscribe, and find Nurse Rosa at "Nurse Rosa Speaks" on all platforms Links: Break Up Big Medicine Coalition: breakupbigmedicine.com Share your prior authorization story: earful.us/c/prior-auth Follow Nurse Rosa on LinkedIn and all social media: @NurseRosaSpeaks