When the Levee Breaks: Health Insurers Face a Long-Delayed Moment of Accountability

For the healthcare insurance industry, a long-avoided moment of accountability may finally be arriving. With premiums climbing sharply, record insurer profits under scrutiny, and five of the nation’s largest health insurance CEOs now being called before the two primary health committees in the House of Representatives, the storm that has been gathering for years is no longer theoretical. 

There’s a melancholic and haunting sense of foreboding in the force and echo of the harmonica in the Led Zeppelin classic, “When the Levee Breaks.” It evokes a warning horn before what is likely imminent catastrophe, the sound of rising water headed for breach, or perhaps even the call of an oncoming train. Whatever you picture when you close your eyes and listen to its melodic scream, there is the unmistakable feeling that the opportunity for escape has already passed. 

If it keeps on raining, the levee is going to break. 

And it’s been raining for quite some time.  

The umbrellas and misdirection used in the past to keep us mostly dry and away from the storm became utterly useless during the debate over the now expired enhanced premium tax credits, more commonly known as the ACA subsidies. Pressure mounted from the public, members of Congress, and even the White House (in the way only the president can deliver) to provide more transparency around rapidly rising insurance premium costs.  

While much of the conversation focused on the impact to the ACA marketplaces, those receiving health insurance benefits through their employers face similarly sharp increases in premiums, with North Carolina among the worst states for those costs being shifted to employees. That’s the market, right? Sometimes, it rewards, and sometimes, it hurts. But when paired with record insurer profits, there are a lot of questions that are hard to ignore, especially as individuals are faced with nearly impossible decisions on necessities, including healthcare, amid stagnant or declining resources.  

Years of insurers insisting we look in another direction for answers has a nefarious feel, perhaps not entirely earned, but no longer easily dismissed. And now representatives of the industry are being summoned to address their role in the cost of care, publicly and on the record.  

On Jan. 22, five of the largest health insurance company CEOs, representing UnitedHealthcare, CVS Health, Cigna, Elevance Health, and Blue Shield of California, will appear before the House committees on Energy and Commerce and Ways and Means. The hearings are the first in a planned series examining the root causes of rising healthcare costs and the role played by large insurers in affordability. 

They are going to demand more than just “well, but…” 

Don’t it make you feel bad? When you’re trying to find your way home? You don’t know which way to go… 

The hot seat is usually warmed first by speculation, then by fact. It’s true that the drivers of rising healthcare costs in the United States are many and not just an insurance issue. But it’s past time for insurance companies to be held publicly accountable for the role they play.  

We hope policymaker inquiries are serious. We hope they are replicated at every appropriate level of government. We hope the days of being able to cut a check to a PAC to make everything go away or to conveniently redirect the focus can’t be taken for granted, especially in an election season.  

Because we’re watching closely. Americans struggling with the costs of care are watching closely. And it’s not schadenfreude. It’s not to point fingers or celebrate or rub it in. The perpetual blame game is exhausting for everyone. 

The truth is we should be as worried about the outcome as the insurance companies. Because if the healthcare system is not willing to be accountable to itself for all the pieces that created this conundrum, then a solution will be imposed from the outside.  

It may look good and even seem durable – but if we aren’t part of shaping a solution, we all know it’s more than likely to be a temporary plug or bandage. The cycle will continue. Insurance companies will be back here again. We’ll all be back here again. And it’s always going to be raining somewhere. 

This week is an opportunity to open up the conversation. Take accountability. Count us in for the long haul in figuring it all out. Yes, we know that commitment will be uncomfortable for all stakeholders, including us. It’s not too late. But it is time. 

And if accountability does not follow – if it does not follow collectively – there is only one direction left to travel.  

Going down, going down now, going down…