A trio of leading congressional Democrats expressed alarm Wednesday about increasingly widespread abuses and care denials by for-profit Medicare Advantage insurers as allies of GOP presidential nominee Donald Trump aim to massively expand the for-profit program.
"We are writing to express our concerns on ongoing problems with Medicare Advantage (MA) that seem to be getting worse," Sen. Ron Wyden (D-Ore.), Rep. Frank Pallone Jr. (D-N.J.), and Rep. Richard Neal (D-Mass.) wrote in a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services (CMS).
"We are concerned that in many instances MA plans are failing to deliver, compromising timely access to care, and undermining the ability of seniors and Americans with disabilities to purchase the coverage that’s right for them," the Democratic lawmakers continued. "We continue to hear alarming reports from seniors and their families, beneficiary advocates, and healthcare providers that MA plans are falling short, and finding a good plan is too difficult."
Wyden, Pallone, and Neal pointed specifically to MA plans' growing use of prior authorization, a complex, barrier-ridden process whereby doctors must demonstrate a proposed treatment is medically necessary before the insurer will cover it.
The process is notorious for harming patients—sometimes fatally—but 99% of MA enrollees are required to obtain prior authorization for at least some medical services, according to the health policy research group KFF.
"Overuse of prior authorization is not only harmful to patients, it hinders healthcare providers' ability to offer best-in-class service," the congressional Democrats wrote, pointing to MA plans' increasing use of artificial intelligence-backed algorithms to decide whether to accept or deny patients' coverage claims.
The lawmakers also voiced concerns about MA plans' deceptive marketing practices—which are particularly dangerous to people with disabilities, as they could potentially be duped into enrolling in an MA plan that doesn't meet their health needs.
"We call on CMS to use every regulatory, oversight, and enforcement tool at the agency's disposal to rein in rampant misuse of prior authorization, simplify the experience of choosing a Medicare plan, and put an end to rampant marketing abuses," the lawmakers wrote.
The Democrats' call for a crackdown on MA abuses stands in stark contrast to a plan put forth by Project 2025, which has proposed making Medicare Advantage the default enrollment option for the nation's seniors—a change that one critic said would mean "destroying Medicare as we know it" while providing a huge boon to private insurance companies.
Though Trump has attempted to distance himself from Project 2025, some 140 people who served in his first administration helped craft the far-right agenda, and one architect of the proposals said earlier this year that the Republican nominee is "very supportive of what we do."
The Guardian's Jessica Glenza reported this past weekend that "one of Republicans' only healthcare policy specifics involves further privatizing" Medicare by boosting Medicare Advantage, privately run plans that have proven significantly more costly than traditional Medicare without obvious improvements in quality of care—leading some experts to call for the program's abolition.
Glenza noted that Project 2025's healthcare proposals were authored by Roger Severino, who previously served as Trump's director of the Office of Civil Rights at the U.S. Department of Health and Human Services.
Just over half of the Medicare-eligible population in the U.S. is currently enrolled in a Medicare Advantage plan, according to KFF.
The Medicare Payment Advisory Commission, a nonpartisan congressional agency, has estimated that the federal government will spend $83 billion more funding MA plans in 2024 than it would have paid to cover the same patients under traditional Medicare.
A recent analysis by the Center for American Progress (CAP) projected that "if making MA the default option for enrollees were to expand the proportion of Medicare beneficiaries in MA to 75%... wasteful spending could approach an eye-popping $2 trillion over 10 years."
"Project 2025 would put more control in the hands of profit-driven corporations by making MA the default enrollment option for Medicare beneficiaries," CAP concluded. "Corporations, not doctors or patients, would be able to control what care an even greater number of enrollees can and cannot receive, while enriching their bottom lines and threatening Medicare's future."
