On December 5, a day after UnitedHealthcare’s CEO was gunned down in cold blood, Anthem announced that it was reversing a proposed policy about anesthesia time limits that would have gone into effect in three states on February 1, 2025.
Social media promptly erupted with reactions like this:
It’s comforting, and even gratifying and empowering, to believe the narrative that a public backlash in response to an extremely ill-timed announcement was successful in stopping an insurance giant.
The problem?
The facts don’t bear that narrative out.
The Policy Wasn’t A New Idea
First, this wasn’t a new idea or an isolated instance. In March 2023, Blue Cross and Blue Shield of Massachusetts had announced a similar policy about anesthesia during colonoscopies. The effective date was originally announced as July 1, 2023, but was later amended to January 1, 2024. The American Gastroenterological Association, American Society of Anesthesiologists, and the American Society for Gastrointestinal Endoscopy subsequently released a strongly-worded objection, and started a grassroots campaign including social media campaigns, local organizing, and lobbying of state officials.
Interestingly enough, one of the letters written by the physician lobbies actually admitted that a major reason (PDF Link) for opposing the change was because gastroenterologists were no longer being properly trained on all the various sedation methodologies available [emphasis is mine]:
As we have noted previously, recently trained endoscopists lack experience administering moderate sedation due to a shift in endoscopist sedation training during fellowship. Consequently, a lot more trained nurses would be needed to handle this aspect of patient care. Compounding this challenge is a severe workforce shortage across the healthcare continuum, particularly affecting nurses trained in administering moderate sedation.
In other words, the objection to using the alternative of moderate sedation was happening because industry training had been amended to exclude it! Boston.com further noted that:
[P]atients with chronic illnesses, conditions that warrant more frequent colonoscopies, a previous failed procedure, or a phobia of medical procedures are just a few examples of those who could qualify for deep sedation.
Exceptions were written into the policy from the beginning, but that still wasn’t good enough for physicians, even though the guidelines being quoted were their own (a fact also admitted to in the PDF link above). Backlash, lobbying, and grassroots organizing continued, and on January 25, 2024, BCBSMA reversed the policy change.
Clearly, insurance companies were already becoming concerned about the charges for anesthesia associated with routine procedures, which were estimated as adding $150 to $1,500 extra onto the charges for routine colonoscopies.
The Connecticut/New York/Missouri Change Was Announced in November
Anthem, which operates the Blue Cross Blue Shield programs in several states, announced their own policy change not on December 4 (the date the media backlash began), but on November 1, 2024, with an effective date of February 1, 2025. The American Society of Anesthesiologists issued their objection (PDF Link) on November 12. The change, and objections to it, had been picked up by local media in the three affected states by late November.
It wasn’t until December 4th, following Mr. Thompson’s assassination, that Anthem’s policy change began making national headlines. The timing was immediately denounced as tone-deaf. It would have been, had they actually announced it then, but by this point the announcement had been out for weeks. It just had been seen as a local news item.
I’m not sure which media outlet first reported Anthem’s anesthesia guidelines on a national scale, but it was all over the place within hours. My team did some digging the next day, in response to an email we’d received, and discovered that these breathless media reports were short on details but long on outrage. In several cases, we spotted actual factual inaccuracies in the news coverage. Most of these were “fixed” by the end of the day on December 6, but the initial outrage stood.
It Wasn’t Reversed in a Single Day
As I’ve shown above, grassroots organizing in response to Anthem’s anesthesia policy changes had already begun well before Mr. Thompson was gunned down.
While there was no public announcement of Connecticut’s and New York’s objections until December 4th or December 5th, conversations had already been going on. As early as November 22, Connecticut State Senator Jeffrey Gordon had a letter stating that at least some limitations had already been agreed upon in Connecticut. Lobbying and organizing had continued apace.
What many people may not understand is that the decision to implement was not made by a single person at Anthem. There were committees and studies, contacts with the Center for Medicare and Medicaid Services (as the latter decision invoked their guidelines), recommendations and considerations. Anthem definitely would have had their legal counsel review the decision before finalizing it. If nothing else, that’s because the decision represented a “Summary of Material Modifications” under applicable law, which meant that certain notice-time requirements had been triggered.
In a like manner, the decision to reverse likely was not made by a single person at Anthem either. The November 22 letter was written by Anthem’s senior director of government relations, not their chief medical officer. This sort of sweeping change could have been mandated by a CEO, but that works a bit the same way that a Presidential mandate does: the mandate itself might be quick, but the methodology for carrying it out takes a little longer to determine. In practical application, CEOs don’t involve themselves in such granular decisions anyway. They have section chiefs to handle or delegate that sort of thing.
(The same can be said for other chief executives. It’s reasonably likely that New York Governor Hochul didn’t find out about it until December 4th. The New York Division of Financial Services would have mentioned the situation in their reporting, but only as one among a list of all the other things it was working on. At least some of those reports never would have been deemed important enough to make it all the way to the governor’s desk; they’d have been handled by DFS Superintendent Adrienne Harris or her staff.)
Conclusion: Public Opinion Wasn’t the Reason
I’m not defending Anthem’s decision to issue the anesthesia policy. But even a cursory check of facts shows that the one reason its reversal did not happen was because of public outcry on December 4th and 5th. The topic had already been under debate for a month by the time Mr. Thompson was murdered, and at least one reversal action had already been documented.
Further, corporate CEOs, in general, are well-known for ignoring or brushing off public opinions. They’re not responsible to the general public; they’re responsible to the corporation’s directors and/or its shareholders. To get a CEO’s attention, it’s necessary to show how something affects the corporation’s own financial bottom line, which is what they oversee. Put more bluntly: Anthem’s CEO had no reason to care about the court of public opinion.
I’d like to believe that public outcry can affect corporate decisions too, and I certainly don’t agree that such things never affect corporate decision making. But the facts themselves clearly show that Anthem’s policy and its reversal were likely already well underway by the time UnitedHealthcare’s CEO was murdered. The timing of the reversal announcement was the only thing that was affected by media reports and backlash. The rest of it is correlation without causation.