Patients, Advocates Push Biden to 'Reclaim Medicare' From Privatized Medicare Advantage

Patients on Medicare Advantage spoke out against the privatized plans this week as part of a coordinated campaign to shed light on the program's care denials, treatment delays, and overbilling—and to pressure U.S. President Joe Biden to rein in the insurance giants raking in huge profits from such abuses.

"These corporations do nothing to increase positive outcomes in medical care. So don't fall for their bullshit," Jenn Coffey, a retired EMT from New Hampshire, said during a livestream hosted by People's Action on Wednesday night.

The stream featured testimony from several patients who have experienced the kinds of delays and denials for which Medicare Advantage is notorious.

Rick Timmins of Puget Sound Advocates for Retirement Action said it took five months and "multiple calls and emails" for his insurance company to approve his referral to a dermatologist for a suspicious lump on his earlobe that turned out to be malignant melanoma. The delay stemmed from a byzantine process known as prior authorization, whereby doctors are required to prove a treatment is necessary before an insurer will cover it.

By the time his referral to a specialist was approved, Timmins said, the previously tiny lump "had tripled in size" and was "quite painful."

Coffey, for her part, ended up on a UnitedHealth Medicare Advantage plan after she was diagnosed with breast cancer in 2013. She later developed two rare diseases—including complex regional pain syndrome—and required expensive treatments that her Medicare Advantage plan refused to cover.

"If Medicare Advantage has it their way, they're going to deny me care and delay me care until I'm dead," Coffey, a healthcare advocate, said in a video published Thursday by the advocacy group Be A Hero as part of a social media day of action against the for-profit plans.

"They only make money when they don't have to spend it on you," said Coffey.

Once enrolled in a Medicare Advantage plan, patients often find it difficult to get out.

"They like to tell you: 'Medicare Advantage numbers are so high, can't you tell people love it?'" said Coffey, alluding to the fact that more than half of all eligible Medicare beneficiaries are now enrolled in a Medicare Advantage plan. "No, we don't. We're stuck. It's the Hotel California: You can check in, but you can't get the hell out."

Next month, the Biden administration is expected to finalize 2025 payment rates for Medicare Advantage, which is funded by the federal government. Medicare Advantage plans frequently overbill the government by making patients appear sicker than they are.

An analysis released last year by Physicians for a National Health Program estimated that Medicare Advantage plans are overcharging U.S. taxpayers by as much as $140 billion per year—an amount that could be used to completely eliminate Medicare Part B premiums or fully fund Medicare's prescription drug program.

Patients and advocacy groups are calling on Biden to "not fork over more money for insurance companies like UnitedHealthcare," as Coffey put it during Wednesday's livestream.

A petition sponsored by Social Security Works urges Biden to "reclaim Medicare" from Medicare Advantage providers, which "have delayed and denied care to millions of Americans in order to turn a massive profit."

"Medicare Advantage isn't really Medicare, and it isn't an advantage to the seniors and people with disabilities who rely on the program," reads the petition, which has over 22,800 signatures as of this writing. "In the 25 years that it has existed, it’s clear that Medicare Advantage is riddled with the same problems as the rest of private insurance: Opaque bureaucracy and extraordinary fees. Seniors who enroll in these for-profit plans are being price-gouged by massive corporations."

The Biden administration has proposed a 3.7% payment increase for Medicare Advantage in 2025—a change that insurers have portrayed as a cut. But Social Security Works noted in response to the industry's complaints that "MA companies are not hurting for profits."

"In 2022 alone, seven healthcare companies that comprise 70% of the MA market brought in over $1 trillion in total revenue and over $69 billion in profits, and spent $26.2 billion on stock buybacks," the group observed. "These same companies claim that if the government doesn't increase their already bloated payment rates, they will have no choice but to slash benefits for patients. This is false, and should be seen for what it is—MA plans holding patients hostage to extort the government for profits."

In an op-ed for STAT last month, former insurance industry insider Wendell Potter—who is now an outspoken critic of private insurers—and John A. Burns School of Medicine professor professor Philip Verhoef wrote that "private plans have no business administering Medicare benefits."

"Traditional Medicare is already more efficient than its private counterpart, in large part because the approval process is much simpler and there aren’t the same incentives to upcode," the pair wrote. "Traditional Medicare spends far less of its funds on administrative overhead, and overall it spends less money per patient than Medicare Advantage while providing far superior access to doctors, hospitals, and treatments."

"Medicare Advantage isn't working for any group: the government, patients, taxpayers, and now even investors," they added. "It's time to turn to what we already know works. We need to support and strengthen traditional Medicare."