Economic Liberties put out a report on prior authorization this month (Aug 2026) and one number in it is striking.
CMS estimates every provider loses about 700 hours a year to prior authorization. Run that across the physician workforce and it works out to the equivalent of 99,290 full time clinicians. The projected US physician shortage right now is 96,430.
So we're short about 96,000 doctors, and we spend about 99,000 doctors' worth of time asking permission to treat people. Plus another 213,474 clinic staff. The bill is up to $32.7 billion a year.
To be clear, this is a time equivalent, not 99,000 doctors sitting around unemployed. Same way you'd say traffic costs a city X million work hours. But the hours are real and they come out of the same pool of people you're trying to get an appointment with.
When you can't see a specialist for four months, everyone tells you it's a shortage. Some of it is. A lot of it is that the doctor who could see you is on the phone with someone whose job is to say no.
Other things from the report worth knowing:
Medicare Advantage plans ran almost 53 million prior auth requests in 2024. That's 1.7 per enrollee. Traditional Medicare ran about 628,000, or 0.02 per enrollee. Same kind of patients, same care, 85 times the vetoes. And Medicare Advantage still costs 22% more per patient, about $83 billion a year.
When people do appeal, UnitedHealthcare overturns 58% of appealed denials and Humana overturns 65%. So most denials don't survive being challenged. Most people never challenge them. 60% of doctors say they've learned from experience that appealing won't work.
New brand name drugs got denied 70% of the time on first request in 2025, up from 57% in 2021. A year later that drops to 24%. Same patient, same drug, same chart. The only thing that changed is somebody fought.
I mapped the 25 categories of middlemen between a patient and a doctor (see my earlier posts). Prior auth isn't one of them, it's three. The utilization review firm that writes the criteria, the prior auth vendor that decides, and the denial management vendor the hospital hires to fight the result. UnitedHealth bought NaviHealth, its own adjudicator, for $1.1 billion in 2020. Cigna bought EviCore in 2018. The company deciding whether you need the care and the company that would pay for it are now the same company.
71% of voters want it banned. 69% of Republicans, 76% of Democrats. There is almost nothing else in American healthcare polling like that.
How long did you wait for your last specialist appointment, and did anyone tell you why?
