RFK Jr. Implements Major Insurance Reform

In a sweeping move to dismantle one of the most notorious barriers in modern healthcare, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz announced Monday a landmark agreement with the nation’s largest health insurers to reform the prior authorization process. The initiative is expected to impact nearly 260 million Americans and marks one of the most significant administrative overhauls in recent health policy history.

The prior authorization system, originally designed to reduce costs by requiring insurance approval for specific treatments and procedures, has become a widespread source of frustration for patients and physicians alike. In recent years, it has come under fire for delaying access to necessary care, denying life-saving procedures, and contributing to physician burnout. Estimates suggest that over 85% of Americans have encountered such delays, and data from 2023 revealed 3.2 million denials within Medicare Advantage plans alone—delays affecting 32 million enrollees, often with severe consequences.

RFK Jr. just slashed one of the biggest administrative burdens in healthcare.

“85% of Americans say that they have had delays in health care because of prior authorization.”

“Doctors report that it cost them 12-15 hours a week filling out forms.”

“Some nurses are spending over… pic.twitter.com/KUs3m7xeCn

— Holden Culotta (@Holden_Culotta) June 23, 2025

Physicians, according to CMS data, now spend an average of 12 hours each week managing roughly 40 prior authorization cases, compounding stress, eroding trust in the system, and draining resources from direct patient care. The burden has sparked calls for reform across the political spectrum, with Kennedy framing the announcement as a culmination of long-standing efforts to correct a system that punishes patients in moments of vulnerability.

The agreement, which includes UnitedHealthcare, Aetna, Cigna, Humana, Centene, Elevance Health, Guidewell, the Blue Cross Blue Shield Association, and the trade group America’s Health Insurance Plans, encompasses nearly 80% of insured Americans. Participating insurers have pledged to adopt electronic prior authorization using FHIR-based interfaces, reduce the number of procedures requiring prior approval by early 2026, preserve prior authorizations through insurance transitions, and dramatically expand the use of real-time decisions—most of which are expected to be approved instantly by 2027.

All clinical denials will be reviewed by qualified medical professionals, and new standards for transparency and appeals will be enforced through CMS oversight and deadline-driven accountability mechanisms. The deal is structured with measurable benchmarks and external monitoring to avoid the shortcomings of earlier efforts.

The announcement also drew comparisons to prior reform efforts, particularly a 2018 initiative launched during the Trump administration that failed to produce lasting change. This latest agreement, however, incorporates enforceable obligations, timeline guarantees, and federal scrutiny to ensure compliance.

Kennedy highlighted past failures, including a case in which a New Jersey patient with severe heart failure was denied a critical medical device despite transplant approval. The patient ultimately received the intervention, but the doctor was sued—a case that underscored the ethical and legal risks physicians face under the current system.

The initiative marks Kennedy’s first major health insurance reform since assuming office as HHS Secretary. He acknowledged President Donald Trump’s role in setting the stage for insurer cooperation, attributing the breakthrough to a climate of executive resolve and political pressure for results over rhetoric.

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