The cost of healthcare consistently ranks as a top economic worry for Americans, but a new report from the Kaiser Family Foundation (KFF) reveals another significant burden for those with health insurance: prior authorization. The process – requiring approval from an insurance company before receiving certain tests, treatments, or medications – is now identified as the single biggest hurdle to accessing care, surpassing even difficulties with appointment scheduling or understanding medical bills.
According to the KFF Health Tracking Poll, approximately 69% of insured adults find prior authorizations to be either a major or minor burden. Specifically, one in three (34%) describe it as a “major burden,” while an additional 37% consider it a “minor burden.” This figure is notably higher than the percentage of insured adults who find issues with understanding bills (60%), securing appointments (60%), or locating in-network providers (53%) to be burdensome.
When asked to pinpoint the single biggest obstacle to healthcare access beyond cost, prior authorizations were chosen by 34% of insured adults. This was significantly more than the 19% who cited difficulty getting appointments, the 17% who struggled with billing comprehension, and the 15% who had trouble finding accepting providers.
The impact of prior authorization is particularly pronounced for individuals managing chronic conditions. Approximately four in ten (39%) insured adults with a chronic illness identify prior authorizations as their greatest healthcare challenge, more than double the proportion who cite other issues. What we have is understandable, as those with chronic conditions often require ongoing medical care and, more frequent interactions with insurance companies for approvals.
The challenges extend beyond simply finding the process annoying. The poll highlights that two-thirds of adults view delays and denials of healthcare services by insurance companies as a “major problem,” with an additional 24% considering them a “minor problem.” These delays and denials aren’t merely administrative inconveniences; they can have tangible negative consequences for patients’ well-being.
In the past two years, roughly one-third of insured adults (33%) have experienced a denial of coverage for a prescribed service, treatment, or medication. Similar proportions (29% each) report delays in receiving care or being required to try a less expensive alternative before their initially recommended treatment was approved. These experiences are even more common among those with chronic conditions, with approximately 42% reporting a denial, 37% a delay, and 38% being required to try alternative treatments.
The consequences of these denials and delays are significant. One-third of those who experienced such issues reported a “major negative impact” on their mental health and emotional well-being, and about one in six noted a major negative financial impact. One in four reported a “major negative impact” on their physical health. These findings underscore the real-world harm caused by administrative hurdles within the healthcare system.
Interestingly, the burden of prior authorization appears to be widespread across different political affiliations and insurance types. The KFF poll found that insured adults across the political spectrum, as well as those with Medicaid, private insurance purchased on the individual market, and employer-sponsored coverage, all identify prior authorization as a significant challenge. Even among Medicaid enrollees, where finding in-network providers can be a substantial issue (cited by 28% as their biggest burden), prior authorization remains a more frequently cited concern.
The findings from this KFF Health Tracking Poll add to a growing body of evidence highlighting the frustrations and challenges patients face when navigating the healthcare system. While controlling costs is a legitimate concern for insurers, the current prior authorization process appears to be creating significant barriers to timely and appropriate care, particularly for those with ongoing health needs. The data suggest a need for a reevaluation of these processes to streamline approvals and minimize the burden on both patients and providers.
