For years, Big Insurance and their allies have argued that the Medicare Advantage program represents the future of Medicare — a more efficient alternative to Traditional Medicare that delivers better care at lower cost. But as too many Americans know, the reality has turned out quite differently.
Today, more than half of all Medicare beneficiaries are enrolled in private Medicare Advantage plans operated by some of the largest insurance corporations in America. These companies receive hundreds of billions of taxpayer dollars each year to provide seniors’ care. Yet mounting evidence from government watchdogs, physicians, patients and lawmakers suggests the program has become a case study in what happens when Wall Street gets involved in the health care of American seniors.
Medicare Advantage plans routinely subject patients to prior authorization requirements that can delay or deny medically necessary care. They often rely on narrow provider networks that can make it difficult for enrollees to access specialists and hospitals. Investigations by federal regulators have found that insurers have improperly denied care that should have been covered and have exploited Medicare’s payment system through aggressive coding practices that increase government payments and corporate profits.
On the latest episode of the HEALTH CARE un-covered Show, we speak with three policymakers who are pushing back on what Medicare Advantage has become.
One of them is former Congressman Jim Greenwood, a Republican who helped author the Medicare Modernization Act of 2003 — the legislation that created Medicare Advantage’s modern framework. Greenwood was one of the program’s architects. More than two decades later, he says Medicare Advantage is not what lawmakers intended.
We are also joined by Congressman Greg Murphy, a Republican physician from North Carolina and co-chair of the GOP Doctors Caucus. Murphy has become increasingly outspoken about waste, fraud and abuse within Medicare Advantage.
And finally, we hear from Congressman Mark Pocan from Wisconsin, one of Medicare Advantage’s most persistent critics on Capitol Hill. Pocan has introduced numerous bills aimed at curbing insurer abuses, reducing prior authorization burdens, cracking down on overpayments and strengthening Traditional Medicare.
What makes this conversation so noteworthy is that concern about Medicare Advantage is no longer coming only from patient advocates or health care reformers. Increasingly, lawmakers across the political spectrum are recognizing that something is deeply wrong when private insurers can collect ever-growing taxpayer subsidies while patients face barriers to care and physicians face mounting administrative burdens.
Whether Congress has the appetite to reform Medicare Advantage or fundamentally rethink the program remains an open question. But the thing that has become increasingly clear is that the bipartisan scrutiny facing Medicare Advantage and the Big Insurance companies that run the plans would have been almost unthinkable just a few years ago.
