Fred Schulte and Holly Hacker report for KFFHealthNews on the power of the health insurance industry to reap extra billions from Medicare with near impunity. Millions of dollars in lobbying money and campaign contributions have helped the biggest health insurers to continue to collect and keep tens of billions of dollars in Medicare overpayments. The government appears unwilling or unable to recoup these funds.
Anyone who doesn’t trust government to do the right thing should recognize that the government can’t control the health insurance industry to do the right thing. And, unlike the government, big health insurers have the money, the power and the financial incentive to put their profits ahead of the needs of older adults and people with disabilities with Medicare. A combination of political contributions large enough to oust members of Congress when they are up for re-election if they don’t support the health insurers, huge investments in marketing and lobbying Congress, and money to outspend the government in any lawsuit, put the health insurers in control.
When you couple insurer control over policymakers with a gameable Medicare Advantage payment system, limited government dollars for oversight and enforcement of the insurers, and 4,000 different Medicare Advantage plans, it’s to be expected that the big losers in the long run will be our nation’s older adults and people with disabilities and taxpayers.
Working alongside many experts and advocacy organizations, I’ve spent more than two decades trying to reform Medicare Advantage to little if any effect. Overpayments are projected to be as much as $1.4 trillion over the next 10 years and inappropriate denials of care and coverage are on the rise. Whatever people believe to be the deficiencies of Traditional Medicare, it is far more cost-effective and it is far easier to oversee than Medicare Advantage.
Here’s more from Just Care:
- Ten ways to improve Medicare Advantage
- 33 experts call on CMS to continue reining in Medicare Advantage overpayments
- Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Sen. Warren and Rep. Jayapal urge CMS to end Medicare Advantage overpayments, punish bad actors
- To protect older adults and people with disabilities, Congress must add an out-of-pocket cap to Traditional Medicare
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