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single-payer
How Medicare Advantage Is Hurting Workers
How Medicare Advantage is hurting workers
Jul 03, 2025
In 2017, Gary Bent was notified that his healthcare benefits were changing. Mr. Bent, a retired professor who taught at the University of Connecticut, received his Medicare coverage through his former employer. Prior to 2017, Gary was covered by traditional Medicare and a supplemental MediGap policy (which covers the 20% of medical costs not paid by traditional Medicare). However, in 2017 the state of Connecticut and Bent’s union renegotiated healthcare benefits for retired employees and entered into a Medicare Advantage contract.
Medicare Advantage is a for-profit, privately administered healthcare plan which covers people over the age of 65, or who have qualifying disabilities. Unlike traditional Medicare—the widely popular, government-run healthcare program that has covered America’s seniors for nearly 60 years—Medicare Advantage is rife with complaints of delays and denials of care, restricted provider networks, and the usual shortcomings of a for-profit healthcare system.
Years later, in June of 2022, Gary Bent had a recurrence of melanoma in the form of a bleeding lesion in his brain. Following a brain surgery, his neurosurgeon recommended he stay at a specialty hospital that could provide intensive care during his recovery. Despite being accepted as a patient, his Medicare Advantage plan said he had to go to a different facility, which his daughter, Megan Bent, described as “substandard.”
While he was in the rehab facility, Gary’s Medicare Advantage provider attempted to discharge him three times; Megan and her mother, Gloria Bent, filed appeals each time, and were twice successful. However, after losing the third appeal, Gary was discharged from the facility. Once he got home, he had a fever and was experiencing neck pain; he had been discharged from the facility while infected with bacterial meningitis.
After being readmitted for another three weeks, he was again discharged from the hospital and remained at home under the care of Megan and Gloria until he passed away shortly after. Following Gary’s death, Megan and her mother learned that Gary’s care was denied by an artificial intelligence program used by his Medicare Advantage provider.
The Bent family’s story is one shared by many families throughout the country, and despite increased criticism of Medicare Advantage in recent years, a growing number of unions have agreed to—or been forced into—moving their retired members out of traditional Medicare with supplemental MediGap coverage and on to these privatized plans.
To address this issue, the Labor Campaign for Single Payer recently hosted a webinar titled “Medicare Advantage and the Privatization of Healthcare: What Unions and Workers Need to Know,” which featured remarks from AFA-CWA president Sara Nelson, Sen. Elizabeth Warren (D-Mass.), and Rep. Pramila Jayapal (D-Wash.). The webinar also included informative and important presentations from Rose Roach, national coordinator for the Labor Campaign for Single Payer and Dr. Belinda McIntosh, board member for Physicians for a National Health Program, as well as testimony from Megan Bent and another Connecticut retiree, James Russell, both of whom are activists with the health justice advocacy organization Be A Hero.
Rose Roach opened her presentation by stating that the organization “never want(ed) to shame a union or their workers.” In truth, negotiators at the bargaining table are in a difficult position when it comes to negotiating retiree health benefits. While traditional Medicare rarely subjects patients to prior authorizations and allows them to see virtually any provider in the country, the program alone only covers 80% of healthcare costs. Therefore, unions must negotiate the purchase of a supplemental (MediGap) policy in order to cover the other 20%, with the combined premiums costing hundreds of dollars a month.
Medicare Advantage plans, on the other hand, often have low- or zero-dollar premiums and include coverage for dental, vision, hearing, and prescriptions (though the value of these additional benefits is often much less than beneficiaries were led to believe). However, patients in Medicare Advantage regularly experience claim denials and are often restricted to seeing a narrow set of in-network providers to get care. Insurance companies seek to maximize their profits by minimizing the amount of care their beneficiaries receive. The long-term costs of having to pay out of pocket for expensive treatments that are often not covered under Medicare Advantage plans can leave retirees and their families under mountains of medical debt.
Union negotiators may embrace Medicare Advantage because they are not fully aware of the long-term costs to their retirees, and because it looks like an opportunity to save money on retiree healthcare, which increases their leverage to bargain for better wages and benefits for in-service workers.
Despite increased public attention to the shortcomings of Medicare Advantage plans, many negotiators do not have the full picture of what it means to enter into a Medicare Advantage contract, and so the Labor Campaign for Single Payer developed a White Paper that highlights many of the important differences between the two options and includes a list of questions for negotiators to ask at the bargaining table, which they hope will result in more informed negotiations and fewer retired union workers ending up on Medicare Advantage.
In her remarks, Sen. Warren asserted that the name “Medicare Advantage” is misleading, arguing that the program “isn’t part of Medicare at all, and certainly not an advantage.”
Congresswoman Jayapal, the lead sponsor of the Medicare for All Act in the U.S. House, urged the attendees to make this issue a top priority in the coming years, saying “we can’t end up with Medicare Advantage for All, we need Medicare for All, and we need your organizing, your mobilizing, and your collective power to fight back against the giant insurance companies that are trying to buy up and destroy the vital public program.”
Indeed, insurance companies like UnitedHealthcare are doing everything they can to increase funding for Medicare Advantage and get as many people on to their plans as possible, often through deceptive marketing tactics and aggressive lobbying campaigns. This is because Medicare Advantage is the leading driver of corporate profits in healthcare.
In 2024, the Medicare Payment Advisory Commission (MedPAC), and independent government commission tasked with advising Congress on Medicare policy, estimated overpayments to Medicare Advantage providers to be roughly $80 billion dollars every year, while Physicians for a National Health Program released a similar report that estimated overpayments could be closer to $140 billion dollars annually. Roach’s presentation analyzed the various ways in which Medicare Advantage providers receive more money than was intended, which include upcoding, favorable selection and deselection, and quality and county bonuses. Of greatest concern to lawmakers on both sides of the aisle is ‘upcoding,’ a term referring to the insurance industry’s fraudulent practice of applying diagnostic codes to a patient’s chart in order to charge the federal government more money.
Insurance companies like UnitedHealthcare are doing everything they can to increase funding for Medicare Advantage and get as many people on to their plans as possible...
Much has been written about upcoding in recent years, including a bombshell report from the New York Times in 2022. Despite this extensive level of news coverage, Secretary of Health and Human Services Robert F. Kennedy Jr. was seemingly caught off guard by a line of questioning from Congresswoman Alexandria Ocasio-Cortez (D-NY), who asked Sec. Kennedy whether he was aware of any ongoing investigations, led by the Department of Justice, into this nefarious corporate practice. Kennedy, befuddled, asked the Congresswoman what she was referring to when she claimed there were “80 million dollars” of overpayments in Medicare Advantage, to which Congresswoman Ocasio-Cortez had to clarify she said “80 billion dollars a year…billion, with a ‘b.’”
A centerpiece of the insurance industry’s public relations campaign to pressure the federal government to increase funding for Medicare Advantage is the claim that the program is solving the health equity gap among eligible Medicare beneficiaries. Studies funded by AHIP, the insurance industry’s biggest lobbyist, claim that Medicare Advantage is providing better care at lower cost to beneficiaries. Dr. Belinda McIntosh repudiated the industry’s claim with a detailed presentation highlighting disparate health outcomes among various racial groups, concluding that beneficiaries who are black, hispanic, or members of “the usual disenfranchised groups are being left with no choice but to accept an inferior product with major problems, that wealthier and more privileged Americans are less likely to accept.” Indeed, as Dr. McIntosh stated, Black and Hispanic beneficiaries were denied care at rates of 20% and 23% respectively by their Medicare Advantage plans, as compared to 15% of claims being denied for White beneficiaries.
While the world of health policy is often laden with statistics and figures, everyone has a story about the shortcomings of the American healthcare system. Stories like that of the Bent family ring true to millions of others, including James Russell, a retired academic who, like Gary, used to work for the state of Connecticut and is on a Medicare Advantage plan. During the webinar, Russell told his story of being diagnosed with stage IV lung cancer and having to seek treatment from a number of different providers in different corners of the country. Megan, Gloria, and James shared their stories and discussed their collaborative work to fight for a better healthcare system as part of their work with Be A Hero.
While the world of health policy is often laden with statistics and figures, everyone has a story about the shortcomings of the American healthcare system.
The Labor Campaign for Single Payer is demanding that the federal government “level the playing field” between traditional Medicare and Medicare Advantage. While the former is constantly under financial strain, the latter benefits from unchecked corporate handouts to insurers, who then increase their profits at the expense of patients by delaying and denying care. Just as is the case when a union negotiator is in a difficult position in picking between traditional Medicare and Medicare Advantage, so too are individual beneficiaries, who must either pay hundreds of dollars a month in premiums for traditional Medicare and a supplemental policy, or instead sign over their Medicare benefits to an insurance corporation that does not care about them. In order to “level the playing field” between traditional Medicare and Medicare Advantage, activists and lawmakers seek to expand traditional Medicare to cover vision, dental and hearing, as well as to set an out-of-pocket-cap on healthcare spending by beneficiaries, which could reduce the necessity of a MediGap policy and thereby reduce the monthly premiums of traditional Medicare.
The Labor Campaign for Single Payer encouraged attendees of the webinar to go to their unions and pass a resolution stating support to level the playing field, which has passed at conventions of the Washington State Labor Council AFL-CIO, the Minnesota AFL-CIO and the Maine AFL-CIO. Additionally, organizers of the webinar encouraged attendees to review and utilize their White Paper to discuss Medicare and Medicare Advantage with their fellow workers and union’s leadership and plan a bargaining strategy that pushes back on the claim that Medicare Advantage is a “win-win” solution to the problem of the high cost of retiree healthcare.
The White Paper, the resolution and the recording of the June 18 Webinar are available on the Labor Campaign for Single Payer’s Resources page, along with a variety of other educational resources on Medicare Advantage and the fight to guarantee healthcare to all workers and people.Keep ReadingShow Less
After The National Day of Action for Single Payer, the Best Defense Is a Good Offense
To eliminate impending Medicaid cuts and other threats to coverage, enact a national, single-payer healthcare system free from all profit, including in the provisioning of care.
Jun 24, 2025
In January, 2025, following the shooting of United Healthcare CEO Brian Thompson, National Single Payer and single-payer activists across the country responded to the righteous anger of the people rising against the health insurance industry by writing a “Manifesto,” which included these four demands:
- The recognition by our government that healthcare is a human right.
- The elimination of private health insurance and the banning of for-profit delivery of care.
- The enactment of a publicly financed, national single-payer program that would provide comprehensive coverage to everyone.
- The transformation of care delivery from profit-seeking ventures into services organized to serve the people of our country, a system in which all caregivers are freed from corporate control.
We called for people across the country to join us in the street on May 31 to raise the demand and put single payer on the nation’s agenda, a reference to the Congressional Progressive Caucus’ 2025 Proposition Agenda released last year which conspicuously omitted a national single-payer program from its agenda (or support for a cease-fire in Gaza).
Over 140 local, state, and national organizations, from central labor councils to social justice organizations, from political parties to physicians’ groups, endorsed the four demands, and more than 30 cities in 17 states held actions demanding that single payer be put on the nation’s agenda.
Endorsing organizations representing 28 states plus the District of Columbia were predominately social justice organizations, whose primary mission is not healthcare. Down Home North Carolina, an organization that mobilizes rural communities in North Carolina to improve the lives of working families, endorsed. So did EX-Incarcerated People Organizing in Wisconsin, which works to end mass incarceration. As did the Kentucky Alliance Against Racist and Political Repression, founded to mobilize people of color and whites to take action against racism in their community. Large organizations such as the California Alliance of Retired Americans, representing 1 million members in California, and small ones such as Pride on the Patio, a community that creates safe and welcoming spaces for LGBTQ+ individuals in Frederick, Maryland, endorsed. The call to put single payer on the nation’s agenda is popular beyond single-payer activists.
Together, let’s build a movement as massive as “No Kings Day,” so formidable that it cannot be denied or ignored.
More than 30 actions were held across the country, including in “Trump country” states such North Carolina, Florida, Texas, Kentucky, West Virginia, Michigan, Pennsylvania, Arizona, and Missouri. Whether from red or blue states, people organized to demand that a single-payer healthcare program free from profit be put on the nation’s agenda.
Notably missing from the list of endorsers were faith groups (only two), “big” labor (aside from the Kentucky State AFL-CIO), and “big” national single-payer organizations.
They still need to be convinced that making a demand of the Democratic Party is acceptable and has broad support.
If the demonstrations on “No Kings Day” are any indication, people are furious with the current administration, but they are no less tired of the Democratic playbook. “No Kings Day” rallies, while enthusiastic and well attended, lacked a central bold demand.
In contrast, activists on May 31 made bold demands, refusing to believe the wealthiest country should have a separate healthcare system for the poor, or that we should wait until we are 65 to access a public healthcare system into which we pay all our working lives. On May 31, activists demanded an end to a system where health insurance CEOs, who worry more about “disappointing investors” than patients, control our health. On May 31, we demanded the end of a system where insurance companies get to make trillions of dollars in earnings and spend millions on federal lobbying to influence government officials who write the laws to benefit the owners and not the people who suffer under it.
In times like these, the best defense is a good offense. To eliminate impending Medicaid cuts; to stop imposing work requirements; to end overpayments to Medicare Advantage and the privatization of Medicare; to prohibit narrow networks, prior authorizations, and delays and denials of care; to end deductibles, medical debt, and bankruptcy, and to negotiate at the bargaining table for higher wages: enact a national, single-payer healthcare system free from all profit, including in the provisioning of care.
National Single Payer and other organizations are going on the offensive, working with labor unions to fight for single payer and mobilizing members of Congress, especially those who have endorsed Medicare for All legislation, to make national single payer a publicly visible fight by asking them to commit to:
- Speak out about national single payer free from profit in “Special Order” speeches on the floor of Congress.
- Support the issue on their website.
- Discuss it at Town Halls.
- Write about it in emails and newsletters.
- Talk about it in hearings, media, and at all public opportunities.
- Improve the current Medicare for All legislation by removing all profit from the provisioning of care.
On May 31 activists from local organizations gathered to demand the healthcare system this nation deserves.
Moving forward, let’s demand our elected officials speak out, support, discuss, write, talk, and improve current Medicare for All legislation. Together, let’s build a movement as massive as “No Kings Day,” so formidable that it cannot be denied or ignored, a movement of millions in the street and in the workplace to put single payer on the nation’s agenda and heal this country once and for all.
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A National Single-Payer Healthcare System Would Be Good for Employers, Too
Job-based insurance poses health-related and financial burdens on company employers and employees. These burdens would disappear with universal healthcare.
May 17, 2025
The National Day of Action is set for May 31, 2025, as a call to action in communities across the United States. The goal is to unite people locally and nationally to eliminate profit-based healthcare. This nonviolent campaign is a collective effort that aims to put National Single Payer on the national agenda. Everyone has a basic human right to healthcare.
This opinion piece shares research findings to advocate for a single-payer healthcare system. Among wealthy countries, the U.S. has by far the most expensive healthcare system, and yet the only one without universal coverage. It is fundamentally broken. The system is inequitable due to differences in insurance availability based on work status, income, and other factors. Individuals of different backgrounds don’t have the same level of access to quality healthcare services. Excess administrative costs for insurers and providers add to an estimate of $504 billion out of $1.1 trillion. The time that it takes providers to complete billing tasks can compromise patient-provider relationships and care delivery.
Employer-sponsored insurance plans are the mainstay of U.S. health insurance. More than 156 million Americans (workers and their families) are covered by job-based insurance. The plans can incur high costs for employees and their families. It also places a burden on employers, including premium payments, time spent managing insurance, and potential compromises to hiring and worker productivity. One study estimated annual transactions costs to companies of $21.6 billion. Time spent by employees dealing with insurance issues may constitute the “sludge” that reduces productivity.
“All my employees are friends of mine. It really pains me to see them not go to the doctor, especially for specialists.”
Researchers at the University of California, Berkeley and the University of California, San Francisco studied the consequences of the U.S. system of health insurance on employers. We conducted seven company case studies, with companies in various industries and of varying sizes. Companies were qualitatively and quantitatively explored for the burdens imposed on employers by providing health insurance to their workers and dependents. We interviewed company owners and managers. Below are summaries of the findings:
- All of the companies care about employee health and financial well-being. They strive to provide reliable health insurance, though employees often have other options (spousal coverage or Medicaid).
- Strategies vary widely in terms of types of coverage. Most companies reported substantial management time overseeing the insurance process. Several companies have utilized brokers or consultants for assistance.
- The two largest companies (both in the manufacturing industry) incurred unique costs related to being self-insured.
- Premium and other financial costs represented 4% to 27% of labor costs. The management cost component is up to 50% of the premium cost. Employee productivity lost to insurance activities was not significant. While there hasn’t been a significant impact on business operations, such as strategies to increase production to meet demand surges, it does affect hiring and can lead to significant costs.
Below are direct quotes from some of those interviews:
“Where [health insurance] really has an impact is who we can hire. The people who would want to work for us would want insurance and so that was always a big barrier to getting talent.”—Owner, Custom Gifts and Products company
“The cost of health insurance has limited, I mean that there’s a certain limit to my profit margin and particularly with other factors such as supply chain issues... I’m getting squeezed on a lot of different fronts, and if my health insurance didn’t go up 10% every year, I could pay people 10% more every year... They don’t want to give up their health insurance, but I think they know that it’s suppressing the wages that we can pay.”—Owner, Print and Design company
“All my employees are friends of mine. It really pains me to see them not go to the doctor, especially for specialists... And our specialist cost is very high... And for some of our employees, especially the warehouse employees, they’re not super high compensation.”—Owner, Aviation Distribution company
To conclude, job-based insurance poses health-related and financial burdens on company employers and employees. These burdens would disappear with the implementation of a national single-payer healthcare system.
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