Finding help for health insurance issues, including unexplained charges, can be difficult when people don't know don't know their way around red tape.
"The health care system is very fragmented," said Jacob Hope, of the health care advocacy group Put People First. "Even elected officials who we've met with – state reps, state senators – they go, 'Yeah, we have people come to us all the time, and we don't know what to do when insurance is denying coverage for a procedure, or the Department of Human Services is denying them for Medicaid.'"
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Hope was among the people who addressed City Council earlier this month, supporting a resolution calling for Pennsylvania to create an Office of Public Healthcare Advocate.
If established, the office would investigate and mediate coverage denials from health insurance companies and excessive billing from medical providers, and serve as a community advocate when hospitals and other medical facilities face closures. It also would help state lawmakers draft regulations that hold insurers and providers accountable.
The City Council resolution passed unanimously and awaits the signature of Mayor Cherelle Parker. It's part of a larger effort to establish such the office. Three states – Rhode Island, Nevada and Connecticut – have similar offices.
Put People First, which has advocated for an Office of Public Healthcare Advocate, has proposed financing the office with a new tax on insurance and health care companies. Additional money funding could come by preventing insurers from wrongfully denying claims – a practice Put People First claims forces people out of the insurance marketplace and onto Medicaid, costing taxpayers. Connecticut's advocate office reportedly saves up to $3 million annually.
"(Today), savings are low, debt is high and the cost of insurance threatens to put many families over the edge," said Councilmember Kendra Brooks, who sponsored the resolution. "Meanwhile, insurance companies are wringing profit out of people and they face no accountability for delaying, denying or overcharging."
The resolution says overbilling can lead to medical debt and other financial hardships at times when patients already are suffering, and emphasizes that "challenging healthcare company decisions is a difficult, opaque, and inaccessible process."
Proponents for an Office of Public Healthcare Advocate have pointed to the closure of Hahnemann Hospital in 2019 as a situation that may have turned out differently with the presence of an advocate. The hospital, which served as a safety net for many, closed after its parent company declared bankruptcy. According to the Pennsylvania Health Access Network, hospital closures are a growing issue across the state.
The office would help people at the individual level, too – particularly with insurance issues. Jeanette Murdock, of Philadelphia, told City Council that her son died from a heart attack in 2022 after an insurer died him blood-thinning medication that his family couldn't afford out of pocket. She said a public health advocate would be a powerful force against "insurance companies, hospitals and others who put profit before people."
"This has to stop, other people will die if they don't get insurance," Murdock said. "People are sick and need insurance."
Establishing the Office of the Attorney General would give it "teeth," Hope said, because it would have the capability to file subpoenas and have the legal power to combat larger issues within the health care system. He said the attorney general historically has acted more independently than other state departments.
"An issue that we're seeing in all parts of the state – rural, urban, suburban – is our health care rights just getting trampled," Hope said. "We can see that with hospital closures, we saw that with COVID. People coming in just profit off of things —there's so many examples of people's health care rights not being protected."
Put People First helped write a bill that passed the Pennsylvania House with bipartisan support, but it has been stuck in the state Senate, and the General Assembly has recessed for the year. For the effort to move forward, a bill likely will need to be re-introduced in the next legislative session.
Getting the office established will require the support of Senate leaders and Gov. Josh Shapiro, Hope said. Though the City Council resolution can't kickstart discussions, it signals strong support from the city's government.
"If it will pass next year, that's what it will take, it'll take us raising our voice and reminding them that it's a priority, that health care is important, (and) is a key issue for people in Pennsylvania," Hope said.