Penetrating health insurers and revealing their business practices
By Taylor Blatchford, Equity in Health Fellow
The private health insurance companies at the heart of health care in the U.S. are notoriously complicated. But as they continue to expand, buying clinics, managing pharmacy benefits and even providing care, it’s essential journalists feel empowered to cover these corporations and understand how they do business.
A panel at Health Journalism 2025 offered insight and best practices for how to do just that.
“Health insurance is so central to how we get our health care, and it’s so important to helping us live quality lives,” said moderator Jonathan Rockoff, health business editor at The Wall Street Journal. “It’s also at the center of a lot of frustration and anger. It’s very complex and very opaque.”
Panelist John Baackes, the former CEO of L.A. Care Health Plan, knows that firsthand. He managed the nation’s largest publicly operated health plan. After UnitedHealthcare CEO Brian Thompson was shot and killed in late 2024, “people gushed out about how they really couldn’t stand insurance companies and the tactics they were using to control costs,” Baackes said.
Panelists suggested three concrete avenues for reporting on these companies:
Look for the data
Health insurance plans are regulated by state insurance departments, and insurance companies have to make routine filings that are public. These filings require insurers to put in writing why they have to raise rates, and sometimes state regulators will push back, said panelist Chad Terhune, a health enterprise reporter for Reuters.
Earnings reports are also a helpful source of information. Baackes advised reporters to pay attention to the medical loss ratio: the portion of insurance premiums an insurer spends on medical care. Looking at how a company’s ratio has changed over time can offer insight into how a company is doing compared to its competitors.
Talk to insurance brokers
These professionals are used to explaining complex insurance concepts to an everyday audience and know the industry inside and out. They’re an “underappreciated source,” Terhune said.
Beyond brokers, hospitals and doctors are good sources: they deal with insurance companies all the time, said panelist Anna Wilde Mathews. State regulators can also help you understand the insurance companies operating in your state.
Follow the use of prior authorization
This practice may be a big issue this year, Rockoff said, as insurers seek to control costs by passing them on to patients. Many people will never call back and appeal when a procedure or medication is denied.
Prior authorization can be a “point of abrasion,” Baackes said. When he managed the L.A. Care Health Plan, he said he requested that the company get rid of prior authorization for codes that were being authorized 99.5% of the time. Approximately 14,000 codes that had required prior authorization were eliminated. “I’m hoping there will be some leaders that set an example,” Baackes said of commercial insurers.
Taylor Blatchford is an engagement reporter covering mental health for The Seattle Times.
