Jayapal, DeLauro, Schakowsky Lead Effort to Protect Enrollees on Medicare Advantage

WASHINGTON – U.S. Representatives Pramila Jayapal (WA-07), Rosa DeLauro (CT-03), and Jan Schakowsky (IL-09) are leading 60 lawmakers in calling on the Centers for Medicare and Medicaid Services (CMS) to enact urgent reforms to Medicare Advantage (MA) plans. Unlike Traditional Medicare, MA plans are administered by private insurers and have been found to be fraught with waste, fraud, and abuse, often sacrificing patient outcomes for higher corporate profit. 

“Corporate health insurers offering MA plans are harming vulnerable patients across the country and endangering the solvency of the Medicare Trust Funds,” wrote the Members. “Supporters of MA claim the program reduces costs. Unfortunately, the MA program has never saved the government money. Other recent data has shown that the bottom 5 percent of MA plans are responsible for 10,000 preventable deaths every year.”

The private insurance companies running MA plans mislead the public by claiming their plans save money and improve care. Studies have found just the opposite: CMS pays 6 percent more per enrollee than it would for Traditional Medicare coverage, wasting billions of dollars every year. Despite these higher costs, insurers administering MA plans provide consistently worse coverage. As an example, it was recently found that patients covered by privatized MA programs are significantly more likely to die in the month following surgery for stomach, pancreatic, or liver cancer compared to those in Traditional Medicare. 

By strengthening Traditional Medicare and taking actions to protect beneficiaries from MA, CMS could save hundreds of billions of taxpayer dollars annually, money that could in turn be used to decrease the cost of Traditional Medicare for seniors and people with disabilities. 

The Members are calling on CMS to: 

1. Ensure insurance companies do not prevent enrollees from getting care by putting up obstacles such as prior authorization, artificial intelligence (AI) algorithms, and limited networks;
2. Strengthen provider encounter and patient data collection and transparency;
3. Rein in overpayments to insurers by adjustment benchmarks and cracking down on deceptive tactics by private companies;
4. Strengthen Medicare through administrative actions, such as lowering Medicare premiums, and support legislative efforts to cap out-of-pocket costs and adjust the physician fee schedule to account for increases in provider costs.

“For far too long, Medicare Advantage plans have been significantly overpaid with little to show for it,” said David Lipschutz, Associate Director Center for Medicare Advocacy. “At the same time, barriers to care that people face in traditional Medicare are often exacerbated when one is in an MA plan.  We urge policymakers to continue the steps that have recently been taken to start to address these problems.” 

“Right now, the government cannot protect people from joining Medicare Advantage plans that endanger their health,” said Diane Archer President, Just Care USA. “And, Medicare Advantage is driving up Medicare premiums by tens of billions of dollars a year and compromising the Medicare Trust Fund. These proposed actions would go a long way towards keeping Medicare strong and honoring Medicare’s commitment to guaranteeing older Americans and people with disabilities good affordable health care.” 

“As a physician, and especially as a gynecologic oncologist, I have personally seen the damage that corporate-controlled Medicare Advantage plans can do to patient care,” said PNHP Vice President Dr. Diljeet Singh, M.D., DrPH. “Narrow networks and onerous prior authorization requirements lead to needless patient suffering and damaging delays in treatment, all in the name of providing more dollars to insurance companies. This letter represents an important step in cracking down on these abuses, and strengthening Traditional Medicare to make sure it stays a viable option for our seniors and people with disabilities.”

“Many Medicare Advantage plans are bad actors who rake in profits by delaying and denying the care seniors and people with disabilities need, while overcharging the government to the tune of $140 billion a year,” said Nancy Altman, President of Social Security Works. “Those plans should be called Medicare Disadvantage! Thank you to Representatives Jayapal, DeLauro, Schakowsky, and all the signers of this letter for fighting to protect Medicare beneficiaries and ensure that they get the high quality health care they’ve earned.” 

“The Medicare Advantage program was created 25 years ago with the promise that the private sector could reduce costs by better managing care. But instead, it has become a shameless profiteering scheme. Through waste, fraud, and abuse of the rules, insurance corporations will be overpaid by taxpayers by at least $88 billion this year — all while wrongly restricting provider networks, and denying and delaying care for many older Americans and people with disabilities” said Dr. Jamila Headley, Executive Director of Be A Hero. “This letter prescribes urgent solutions to these pressing problems. Most critical among them is the need to reclaim the billions of dollars being gouged from taxpayers by large insurance corporations and instead invest these precious resources into improving Medicare and ensuring that this vital public program is there for generations to come”

The letter was signed by Alma Adams (NC-12), Becca Balint (VT-AL), Nanette Barragán (CA-44), Jamaal Bowman (NY-16), Cori Bush (MO-01), Salud Carbajal (CA-24), Greg Casar (TX-35), Kathy Castor (FL-14), Judy Chu (CA-28), Yvette Clarke (NY-09), Steve Cohen (TN-09), Danny K. Davis (IL-07), Christopher Deluzio (PA-17), Mark DeSaulnier (CA-10), Debbie Dingell (MI-06), Jesús “Chuy” García (IL-04), Robert Garcia (CA-42), Sylvia Garcia (TX-29), Daniel Goldman (NY-10), Raúl Grijalva (AZ-03), Val Hoyle (OR-04), Sheila Jackson Lee (TX-18), Henry Johnson (GA-04), Robin Kelly (IL-02), Ro Khanna (CA-17), Andy Kim (NJ-03), Raja Krishnamoorthi (IL-08), Barbara Lee (CA-12), Teresa Leger Fernandez (NM-03), Betty McCollum (MN-04), James McGovern (MA-02), Grace Meng (NY-06), Kweisi Mfume (MD-07), Jerrold Nadler (NY-12), Grace Napolitano (CA-31), Joe Neguse (CO-02), Eleanor Holmes Norton (DC), Alexandria Ocasio-Cortez (NY-14), Ilhan Omar (MN-05), Chellie Pingree (ME-01), Mark Pocan (WI-02), Katie Porter (CA-45), Ayanna Pressley (MA-07), Delia Ramirez (IL-03), Patrick Ryan (NY-18), Mary Gay Scanlon (PA-05), Adam Schiff (CA-30), Mark Takano (CA-39), Shri Thanedar (MI-13), Bennie Thompson (MS-02), Rashida Tlaib (MI-12), Jill Tokuda (HI-02), Paul Tonko (NY-20), David Trone (MD-06), Nydia Velázquez (NY-07), Bonnie Watson Coleman (NJ-12), and Nikema Williams (GA-05).

It was also endorsed by the American College of Radiology, Be A Hero, Business Leaders for Health Care Transformation, California OneCare, Center for Health and Democracy, Center for Medicare Advocacy, Center for Popular Democracy Action, Citizen Action of Wisconsin, Health Care for All- California, Health Care Now, Indivisible, International Association of Aerospace Workers and Machinists – California Conference, Iowa Citizens for Community Improvement, JustCare USA, Labor Campaign for Single Payer, National Health Care for the Homeless Council, National Union of Healthcare Workers, People’s Action, The People’s Lobby, Physicians for a National Health Program, Progressive Democrats of America (PDA), Progressive Maryland, Public Citizen, Rights & Democracy, Social Security Works, and Therapists for Single Payer.

The full text of the letter can be found here. 

Issues: Health Care