The Democrats want the government to invest money in health care to end the government shutdown. Eliminating Medicare Advantage waste, which totals more than $1 trillion over the next decade, would free up tens of billions of dollars a year for health care. A bipartisan bill, the No UPCODE Act, would end about 12.5 percent of that waste and could become law, reports Chris Dickerson for Legal Newsline.
Senators Bill Cassidy (Rep. Louisiana) and Jeff Merkley (Dem. Oregon) introduced the No UPCODE Act (No Unreasonable Payments, Coding or Diagnoses for the Elderly Act) earlier this year. It is designed to change the way insurers do health risk assessments. At the same time, it would make it harder for insurers to add additional codes to patients’ medical records and, in the process, reduce their overpayments.
Estimates are that the No Upcode Act would end $124 billion in Medicare waste over ten years. It would keep insurers from claiming that their enrollees have greater health needs than they really do. That said, experts find that the government is overpaying the insurers in Medicare Advantage about $80 billion a year, so cutting $12.4 billion still leaves a lot of fat.
As a result of eliminating waste, the No Upcode Act also would reduce Medicare Part B and D premiums and strengthen the Medicare Trust Fund.
To be sure, insurers game the Medicare Advantage program in a multitude of ways. They leave markets that are unprofitable, as many are doing at the end of this year. They have their sales agents steer people to their most profitable plans, plans that might not serve their health care needs.
Insurers also don’t compete to treat the people with Medicare who have the greatest health care needs. Have you ever seen an ad from an insurer saying they have the best cancer and stroke program. You never will. They don’t want you if you have cancer or a failing heart. The more they can minimize the amount of costly care they provide to people with complex conditions, the more they profit.
Insurers establish PACs that appear to be grassroots-based in order to block needed reforms. Not surprisingly, one of their PACs misleadingly claims that the No UPCODE Act will raise costs and reduce benefits for older adults. The goal is to make anyone in Congress who supports the Act appear not to support people with Medicare.
Here’s more from Just Care:
- Medicare Advantage overpayments drive up Medicare premiums by $220 billion
- Congressional Budget Office finds $1 trillion in Medicare Advantage overpayments
- New Medicare Advantage rules won’t stop the misleading marketing
- 2025: More older adults gamble with their health in Medicare Advantage
- The Senate reconciliation bill likely won’t target waste in Medicare Advantage
