Prior Authorization Reform: A Missed Opportunity for Kentucky Patients and Physicians
By Evelyn Montgomery Jones, M.D., President, Kentucky Medical Association
We live in a complicated world and try to find ways to simplify it. During this past legislative session, key legislation that would have helped ease the burden of obtaining needed health care stalled and did not pass. While not unusual given the amount of legislation taken up every year, this legislation had virtually no opposition and would have helped every Kentuckian.
House Bill 423 was a long-overdue attempt to address the issue of prior authorizations for health care. The bill negotiated a compromise among physicians, healthcare providers, and insurers: an example of bipartisan collaboration at its best. While it did not go as far as some would have liked, it represented a crucial step toward improving patient care. The bill sailed through the House of Representatives and passed the Senate Banking and Insurance Committee with zero nay votes, only to stall inexplicably on the Senate floor with no public opposition. Those involved in crafting the legislation were left perplexed.
Prior authorizations for health care are rightfully despised by both patients and physicians. Why such processes are in place when 90% are ultimately approved is baffling, since it costs patients more time, money, and effort. We frequently hear news stories in which patients suffered just waiting on permission to obtain a needed procedure. And the administrative/personal costs to patients –unnecessary stress, frustration, and emotional and financial burden—lead to real consequences for Kentuckians. It’s a testament to our overly complex healthcare system.
Physicians across the Commonwealth routinely encounter these delays that prevent timely patient care, forcing many to spend hours navigating an inefficient system rather than focusing on their patients. A survey of Kentucky physicians a few years ago found that of the many issues impacting them, prior authorization ranked number one.
HB 423 presented a golden opportunity to start to fix this broken system. It also would have sent a message to physicians nationwide that Kentucky stood apart from other areas of the country and wanted to do something to make our state a better place to practice medicine. Our physician workforce is already stretched thin, particularly in rural areas, and burdensome prior authorization requirements only exacerbate the problem. As a physician in private practice in Paducah, I have experienced firsthand how these obstacles create unnecessary challenges for both providers and patients.
Despite broad support, the bill became a casualty of politics unrelated to the policy itself. What a shame. The Kentucky Medical Association and other healthcare advocates remain committed to seeing prior authorization reform enacted. This legislation was not just a step in the right direction—it was a signal to doctors and patients alike that Kentucky values accessible and efficient healthcare. It is our hope that lawmakers recognize the urgency of this issue and prioritize passing meaningful reforms in the next legislative session. Otherwise, Kentuckians will continue to suffer from a system that blocks needed health care. The best time to start was yesterday, but the second-best time is now.
