The letter calls for an update to the current risk adjustment model, which is currently putting billions of taxpayer dollars in the pockets of private insurance companies
WASHINGTON – Today, U.S. Representative Pramila Jayapal (WA-07) led members of Congress in a letter to the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) calling on CMS to end private insurers’ profiteering of Medicare Advantage. Senators Bernie Sanders (I-VT) and Elizabeth Warren (D-MA) and Representatives Jamaal Bowman (NY-16) and Katie Porter (CA-45) joined Jayapal in this effort.
Under CMS’s current risk adjustment model, which calculates payments to Medicare Advantage plans, hundreds of billions of taxpayer dollars in wrongful overpayments have been siphoned by private insurance companies instead of going towards care for senior citizens and others covered individuals.
“The current risk adjustment model leads to billions of Medicare dollars going into the pockets of private insurance companies, taking away taxpayer dollars that should be applied for urgently needed medical care for our seniors and people with disabilities. This is a complete diversion from the purpose and spirit of the Medicare program,” wrote the lawmakers. “Given these concerns, we write to urge CMS to improve the risk adjustment model to correct overpayments to MA plans and ensure taxpayer dollars in the Medicare trust fund are disbursed equitably.”
“For too long, policymakers who praise Medicare Advantage have ignored growing evidence that MA costs more per beneficiary than traditional Medicare and is straining Medicare’s finances” said Judith Stein, Executive Director of the Center for Medicare Advocacy. “These excessive payments to MA should end, and the funding should be used to expand critical benefits, such as dental, hearing, vision, and a cap on out-of-pocket costs for all Medicare beneficiaries.”
Members sent the letter in response to a call for public comment by CMS for improvements to its risk adjustment model. The letter calls on CMS to stop funneling taxpayer dollars to private insurers, and instead redistribute those funds to Medicare beneficiaries.
This follows a longstanding effort led by Representative Jayapal to fix loopholes in the Medicare Direct Contracting Program that allow for the same type of profiteering to occur in traditional Medicare.
Center for Medicare Advocacy, Just Care USA, Public Citizen, and Social Security Works all endorsed this effort.
A copy of the letter is available here.