October 2, 2026
The Honorable Ron Wyden
Ranking Member
Committee on Finance
United States Senate
Washington, DC 20510
Dear Ranking Member Wyden:
For more than fifty years, the National Hispanic Council on Aging (NHCOA) has worked to improve the health, economic security, and quality of life of Hispanic older adults, their families, and their caregivers. We appreciate the opportunity to respond to the Senate Finance Committee Democrats’ request for information on Health Coverage That Works for Everyone.
For the older adults we represent, the measure of a health insurance system is not simply whether someone has an insurance card. It is whether that coverage allows them to see a trusted physician, obtain prescribed treatment without unnecessary delay, afford the care they need, and navigate the healthcare system without confronting administrative or language barriers they cannot reasonably overcome.
NHCOA hears from our community that insurance coverage is too often anything but seamless. Hispanic older adults and their families encounter disrupted provider relationships, delayed authorizations, claims denials, and confusing plan requirements layered atop language barriers, limited digital access, and chronic disease. These are not abstract insurance practices. They can determine whether an older adult receives care early enough to remain healthy and independent or waits until a manageable condition becomes a medical emergency.
The RFI asks how policymakers can make health coverage easier to obtain, easier to understand, more affordable, and more useful when people actually need care. It also asks specifically about affordability, provider networks, prior authorization, claims denials, appeals, and administrative burdens. NHCOA welcomes that focus and encourages the Committee to place affordability, transparency, and accountability at the center of future reforms.
Affordability Must Reflect Actual Cost of Receiving Care
NHCOA strongly agrees with the RFI’s focus on the total cost of healthcare rather than premiums alone. This is especially important for older adults and families living on fixed or limited incomes. Affordable premiums have limited value if a beneficiary cannot afford the deductible required before coverage becomes meaningful or the cost-sharing associated with a specialist visit, diagnostic test, procedure, or prescription medication.
NHCOA sees this same challenge throughout our work. A rising grocery bill, higher utility costs, or another unexpected household expense can quickly become the reason an older adult postpones treatment or leaves a prescription at the pharmacy.
Congress should therefore evaluate affordability based on what people must actually spend to obtain medically necessary care. Future reforms should seek to limit unreasonable out-of-pocket exposure and ensure that deductibles, coinsurance, and other forms of cost-sharing do not discourage patients from seeking primary, preventive, and other high-value care. Coverage should provide financial security, not simply protection against the most catastrophic possible expense.
Prior Authorization and Claims Denials Should Not Become Barriers to Care
NHCOA particularly appreciates the Committee’s attention to prior authorization, claims denials, and other utilization management practices. These issues have been a longstanding concern for the older adults and families we represent. Prior authorization and step therapy can have an outsized impact on Hispanic older adults. When an approval is delayed or a claim is denied, an older adult with limited English proficiency, limited digital access, or cognitive challenges may have greater difficulty understanding the decision and determining what to do next. Family caregivers frequently step in to navigate these systems, spending hours on the telephone, completing paperwork, contacting providers, and pursuing appeals while also managing jobs and responsibilities of their own.
The consequences can extend far beyond inconvenience. For an older adult managing diabetes, cardiovascular disease, kidney disease, cancer, or another chronic condition, a delayed authorization can result in a missed medication, cancelled procedure, interrupted treatment, or deterioration in health. A process intended to manage health care utilization should never create unnecessary clinical risk for the patient.
NHCOA therefore encourages Congress to establish stronger standards governing prior authorization and claims denials, require greater transparency regarding how and why coverage decisions are made, and ensure meaningful accountability when plans repeatedly or improperly delay medically necessary care.
Appeals Must Be Understandable and Accessible to Everyone that Needs Them
The right to appeal an insurance decision means little if a patient cannot realistically exercise it.
The Committee’s RFI recognizes that consumers may not understand why a claim was denied, whether they have a right to appeal, or how to begin the process. It further notes that information regarding appeal rights can be difficult for patients to find and understand. These problems can be especially significant for older adults with limited English proficiency, limited digital literacy, cognitive limitations, or no family member readily available to help.
NHCOA encourages Congress to make accessibility a fundamental component of any reform to the appeals process. Denial notices and appeal instructions should be communicated in plain language and provided in languages patients can understand.
Patients should be told clearly why care was denied, what information is necessary to challenge that decision, how much time they have to appeal, and where they can obtain independent assistance.
Congress should also consider stronger reporting and transparency requirements regarding denials and appeals. Policymakers, regulators, patients, and employers should be able to determine how frequently plans deny care, the types of services being denied, how frequently patients appeal, and how often those decisions are subsequently overturned.
A system in which a patient ultimately receives medically necessary care only because they possess the time, knowledge, language skills, or resources to successfully challenge an insurer is not an equitable system.
Provider Networks and Continuity of Care
For an older adult managing multiple chronic conditions, a trusted physician or specialist can represent years of medical history, communication, and coordination of care. Losing that relationship because of an unexpected network change can be deeply disruptive.
As we told House Ways & Means and Energy & Commerce early this year, NHCOA regularly hears from older adults who technically “have coverage” yet struggle to secure timely appointments, maintain trusted providers, access specialists, or obtain prescribed medications without repeated administrative intervention.[1] The RFI appropriately considers stronger protections against disruptions caused by mid-year network changes and asks how plans should be held accountable for the resulting costs and delays.
NHCOA supports the principle that patients undergoing active treatment or managing serious chronic conditions should have meaningful continuity-of-care protections when a provider unexpectedly leaves a network. Provider directories must also be accurate and useful. A network that appears adequate on paper but consists of physicians who are no longer participating, are not accepting new patients, or cannot provide an appointment within a reasonable period does little for a patient seeking care.
Congress should strengthen network adequacy standards, improve the accuracy of provider directories, and protect patients from unnecessary disruption when network arrangements change through no fault of their own.
Administrative Complexity Deepens Existing Disparities
The healthcare system should not assume that every patient has the same ability to navigate it.
Complicated enrollment processes, digital-only communications, difficult-to-understand plan documents, prior authorization requirements, and confusing appeals procedures can impose burdens on everyone. But those burdens can fall particularly heavily on older adults with limited English proficiency or digital access and on families already managing chronic disease.
In many Hispanic families, caregivers become the bridge between the patient and the health care system. They schedule appointments, translate information, communicate with insurers and physicians, manage prescriptions, and challenge coverage decisions. When the insurance system becomes unnecessarily complicated, families absorb those costs in lost time, missed work, and stress.
NHCOA therefore urges Congress to examine administrative burden through the experience of the patient and caregiver, not solely through the experience of insurers and providers. Consumer-facing information should be available in plain language and in appropriate languages and formats. Enrollment, authorization, and appeals processes should be designed so that an older adult can realistically navigate them without requiring professional expertise.
Transparency and Accountability Must Follow Federal Healthcare Dollars
There is a simple principle that has guided NHCOA’s work across federal health programs: when public resources are provided for the purpose of improving patient care, patients should experience the benefit. As we told Chairman Cassidy this past August via a letter, NHCOA has applied this principle in our work on prescription drug affordability and the 340B Drug Pricing Program, where we have called for greater transparency and accountability to ensure that resources intended to help vulnerable patients actually reach them.[2]
The same principle should apply to health insurance. Greater transparency regarding claims denials, prior authorization, network adequacy, administrative spending, and other insurer practices can help policymakers identify where coverage is working and where patients are being failed. Accountability should be measured not simply by whether an insurer complies with a reporting requirement, but by whether beneficiaries can obtain timely, affordable, high-quality care.
For Hispanic older adults, these questions have immediate consequences. A health plan may satisfy technical coverage requirements while a patient remains unable to find a specialist, afford the required cost-sharing, understand a denial, or navigate an appeal. Future reforms should measure success from the patient’s perspective.
Conclusion
The Committee Democrats’ RFI presents an important opportunity to reconsider what Americans should reasonably expect from health insurance. NHCOA believes the starting point should be straightforward: coverage should be affordable to obtain and affordable to use. Patients should be able to receive medically necessary care without unreasonable administrative delays. They should have access to adequate provider networks and continuity of care. When coverage is denied, they should receive a clear explanation and have access to an appeals process they can realistically navigate. And insurers receiving substantial federal support should be accountable for whether the coverage they provide delivers meaningful value to patients.
For Hispanic older adults, their families, and caregivers, these protections can mean the difference between managing a chronic condition successfully and experiencing a preventable health crisis.
NHCOA stands ready to work with the Senate Finance Committee on reforms that strengthen access, affordability, transparency, and accountability while ensuring that health coverage reflects the realities of older Americans and the families who support them.
Thank you for considering our views.
Yanira Cruz, MPH, DrPH
President and CEO
National Hispanic Council on Aging (NHCOA)
[1] NHCOA letter to Chairman Jason Smith, Ranking Member Richard Neal, Chairman Brett Guthrie, and Ranking Member Frank Pallone, January 22, 2026. URL: https://bit.ly/4h9F2MY.
[2] NHCOA letter to Chairman Bill Cassidy, August 26, 2026. URL: https://bit.ly/4jcaY4I.
Recent Comments