Claim Denials Are Huge on Obamacare

Via Andrew Sprung, here is a Kaiser analysis of data from Obamacare claims:

We find that, across issuers with complete data, 19% of in-network claims were denied by issuers in 2017, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 40%.

This is solely for providers on the federal exchange, but it matches data for California, which has its own exchange. Apparently there’s no data for employer insurance to compare this to, but a best guess suggests that the denial rate on Obamacare claims is at least twice that of private employer insurance.

This is fodder for critics of Obamacare on both the right and the left. It’s certainly one way in which health coverage via Obamacare is worse than private insurance, and it’s especially noteworthy given that so many Obamacare providers use narrow networks. After all, the whole point of narrow networks is that customers are forced to see only pre-screened doctors that the insurance company trusts not to overtreat.

At the same time, Medicare almost certainly has a much lower incidence of claim denial, which is yet another mark in favor of universal health care. It is really amazing the number of problems that could be solved by simply giving up the long twilight struggle that’s produced America’s insane patchwork of health care providers and insurers. Employers pay more than they have to, patients pay more than they have to, millions go without coverage at all, and those of us who do have coverage have to put up with terrible service. What an unholy mess.


Mother Jones was founded as a nonprofit in 1976 because we knew corporations and the wealthy wouldn't fund the type of hard-hitting journalism we set out to do.

Today, reader support makes up about two-thirds of our budget, allows us to dig deep on stories that matter, and lets us keep our reporting free for everyone. If you value what you get from Mother Jones, please join us with a tax-deductible donation today so we can keep on doing the type of journalism 2019 demands.

We Recommend


Sign up for our newsletters

Subscribe and we'll send Mother Jones straight to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.


Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.


We have a new comment system! We are now using Coral, from Vox Media, for comments on all new articles. We'd love your feedback.