Representative Mark Pocan (D-WI) introduced eight bills aimed at strengthening traditional Medicare and reining in some of the worst practices in the privately-run Medicare Advantage business. For years, lawmakers have danced around the mounting evidence that private Medicare Advantage plans overbill taxpayers between $80 and $140 billion annually and quietly impose barriers to seniors’ care to boost profits.
Traditional Medicare remains one of the most successful public programs in American history. It was built around a simple promise: If your doctor says you need care, you get it. But as Medicare Advantage has grown, that promise has eroded for millions of people. MA plans are largely run by big insurance conglomerates – like UnitedHealthcare, Elevance and CVS/Aetna – and those insurers decide what care is covered, which doctors you can see and how long you can stay in a hospital. Each cent they have to shell out for your care is a cent they can’t keep in their pockets or split with their shareholders. Wall Street’s relentless demand for more and more of that money incentivizes them to deny or delay care that mean life-and-death for millions of American seniors.
And it’s not just health care policy nerds like me that have been focused on this issue – even the U.S. Department of Justice (DOJ) has taken aim at Medicare Advantage. In February, news broke that the DOJ had launched a civil fraud investigation into UnitedHealth Group, the largest MA insurer, for the company’s alleged use of diagnoses that trigger higher Medicare Advantage payments. And in July, the company confirmed it is the subject of a DOJ criminal investigation. The DOJ reportedly questioned former UnitedHealth Group employees about the company’s business practices.
You can see the entire package of bills on Pocan’s website. They include the Denials Don’t Pay Act, which would force Medicare Advantage plans to face real consequences if too many of their prior-authorization denials are overturned; The Right to Appeal Patient Insurance Denials (RAPID) Act, which would ensure every denial is automatically appealed, sparing sick and elderly patients from navigating a process many never even know exists; and the Protect Medicare Choice Act which would stop insurers and brokers from pushing seniors into Medicare Advantage by default.
Pocan and his co-sponsors understand that Medicare Advantage’s prior authorization hurdles and widespread denials are just Wall Street-directed obstacles that second-guess physicians and delay care. Patients pay the price. Doctors pay the price. And taxpayers pay the price.
A package like this was long overdue.
[This post originally appeared on HEALTH CARE un-covered on November 21.]
Here’s more from Just Care:
- Health care coverage denied? Appeal, it’s easy
- Congressional Budget Office finds $1 trillion in Medicare Advantage overpayments
- 2026: Five things to think about when choosing between Traditional Medicare and a Medicare Advantage plan
- Medicare Advantage gold mine puts traditional Medicare at grave risk
- Seven questions you should be asking this Medicare Open Enrollment period
