SUBSCRIBE TO OUR FREE NEWSLETTER
Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
5
#000000
#FFFFFF
5
#000000
#FFFFFF
medicare advantage
Dr. Oz Nomination Seen as Potential Boon for Medicare Privatization
"Dr. Oz wants to fully privatize Medicare," warned one advocacy group. "That’s why Donald Trump put him in charge of Medicare."
Nov 20, 2024
Dr. Mehmet Oz, whose unsuccessful 2022 Pennsylvania Senate bid included pitching voters on a plan to expand the privatized Medicare Advantage program, is now in a position to potentially actualize that plan.
President-elect Donald Trump announced Tuesday that Oz, also known by his TV personality name Dr. Oz, is his pick to lead the Centers for Medicare and Medicaid Services (CMS).
"Dr. Oz—a massive investor in Pharma—told the voters of Pennsylvania his plans to privatize Medicare… and they rejected him. Now Trump is giving him the authority to see his industry-approved plan carried through," wrote the progressive-leaning outlet The Lever, which covered Oz's support for Medicare Advantage back in 2022.
Through Medicare Advantage, which has been promoted by Trump and other congressional Republicans, seniors can opt out of traditional government-run Medicare health plans and instead choose plans administered by private insurers, such as UnitedHealthcare and Cigna.
According to The Lever's 2022 reporting, Oz pushed Medicare Advantage plans on his show The Dr. Oz Show and co-wrote a 2020 column for Forbes with a former healthcare executive in which they argued that a "Medicare Advantage For All" plan can "save" our healthcare system. In the column, Oz and his co-author articulated a plan to expand Medicare Advantage by imposing a 20% payroll tax.
Oz "is not a good pick for a very powerful position in charge of a trillion dollars of healthcare spending," wrote Matt Stoller of the American Economic Liberties Project on X, in reference to The Lever's investigation.
The Lever also reported that Oz's plan to expand private plans under Medicare Advantage could "boost companies in which he invests." For example, Oz and his wife owned up to $550,000 worth of stock in UnitedHealth Group, at the time of reporting. UnitedHealthcare and Humana account for nearly half, or 47%, of Medicare Advantage enrollees nationwide, according to the health policy organization KFF.
Additionally, a 2022 investigation by The New York Timesfound that major health insurers have exploited Medicare Advantage to boost their profits by billions of dollars.
Project 2025, a list of right-wing policy proposals led by the Heritage Foundation that Trump has tried to distance himself from, calls for making Medicare Advantage the default option for Medicare beneficiaries, which, if enacted, "would be a multibillion-dollar annual giveaway to corporations at the expense of Medicare enrollees and taxpayers," according to the liberal research and advocacy organization the Center for American Progress.
Robert Weissman, co-president of Public Citizen, offered a related critique of Oz: Americans "need someone who will crack down on insurers who want to deny care to the sick, providers who skimp on quality healthcare, corporations that want to privatize Medicare, and Big Pharma profiteers and ideologues who want to slash Medicaid and refuse care to low-income people. What they do not need is a healthcare huckster, which unfortunately Dr. Mehmet Oz appears to have become, having spent much of his recent career hawking products of dubious medical value."
In addition to the potential boon for private insurers, some researchers, news outlets, and members of Congress have also raised concerns about the quality of care administered under Medicare Advantage.
A 2022 government report found that "[Medicare Advantage Organizations] sometimes delayed or denied Medicare Advantage beneficiaries' access to services, even though the requests met Medicare coverage rules" and also "denied payments to providers for some services that met both Medicare coverage rules and [Medicare Advantage Organization] billing rules."
In October, a group of three Democratic lawmakers wrote to the current CMS administrator about increasingly widespread abuses and care denials by for-profit Medicare Advantage insurers.
"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," Sen. Ron Wyden (D-Ore.), Rep. Frank Pallone Jr. (D-N.J.), and Rep. Richard Neal (D-Mass.) wrote in a letter.
"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," they wrote.
In particular, they pointed to Medicare Advantage plans' growing reliance on prior authorization, a complex, barrier-ridden process whereby doctors must demonstrate a proposed treatment is medically necessary before the insurer will cover it.
"Overuse of prior authorization is not only harmful to patients, it hinders healthcare providers' ability to offer best-in-class service," they added.
Social Security Works, a progressive advocacy group, warned in a social media post Tuesday that "Dr. Oz wants to fully privatize Medicare."
"That's why Donald Trump put him in charge of Medicare," the group added. "We will fight to stop this charlatan from getting anywhere near our Medicare system."
Keep ReadingShow Less
Medicare Advantage: A By-the-Numbers Look at This Profit-Seeking Healthcare Scam
Proponents claimed it would lower costs and improve health care for seniors. It has achieved neither of those goals; instead, it has become a wildly profitable scheme for private insurance giants.
Nov 15, 2024
The quasi-privatized system called “Medicare Advantage,” otherwise known as Part C, was created in 2003 as a means of expanding the role of private sector corporations in the publicly-funded Medicare system. Proponents claimed it would lower costs and improve health care for seniors. It has achieved neither of those goals; instead, MA has become a wildly profitable scheme for private insurance giants, who have become adept at taking advantage of Medicare’s billing model to claim exorbitant profits. At this point, MA is more profitable for many companies than their conventional insurance businesses.
And the program continues to grow. Medicare Advantage now has more enrollees than traditional Medicare, thanks in no small part to aggressive public relations campaigns that sell seniors on the idea that the plans cut costs and increase choice. Congress has simultaneously failed to plug the holes in traditional Medicare, pushing seniors towards MA to avoid high out-of-pocket costs. Policymakers can fill these gaps and guarantee true comprehensive coverage simply by redirecting the overpayments to MA insurers into Medicare.
Numerous studies and media investigations have documented the problems with Medicare Advantage. What follows is a collection of some of the most notable figures documenting the high costs of this failed experiment in privatizing Medicare.
$88-$140 billion
The amount that the federal government overpaid private insurers under Medicare Advantage in 2022, according to the Physicians for a National Health Program (PNHP).
$612 billion
The amount that Medicare Advantage plans overcharged the federal government due to upcoding and favorable selection between 2007 and 2023, according to the Medicare Payment Advisory Commission (MedPAC), an independent congressional agency established to advise Congress on issues affecting the Medicare program.
$600 billion
According to one study, this is the projected excess spending between 2023 to 2031 due to the ways that Medicare Advantage plans use ‘upcoding,’ the process of classifying beneficiaries as being sicker than they really are in order to increase payments.
$35 billion
The amount that MedPAC estimates taxpayers will overpay MA insurers this year through ‘favorable selection,’ the practice of targeting healthy seniors for their plans.
$4.2 billion
The amount that MA insurers received for questionable home visit health risk assessments (and related chart reviews) in 2023, according to an October 2024 report from the Department of Health and Human Services.
80 percent
The percentage of mental health providers in a sample of MA plans that were determined to be “ghosts” (meaning they were unreachable, not accepting new patients, or not in-network), according to a recent Senate investigation.
1.8 million
Estimated number of Medicare Advantage customers whose health plans will be canceled in 2025.
167 percent
The amount that drug deductibles will increase for roughly two-thirds of all Medicare Advantage enrollees next year.
55.7 percent
The increase in MA care denials from 2022 to 2023, according to research from the American Hospital Association.
54 percent
The increase in the denial rate for long-term acute care hospitals in Humana’s Medicare Advantage plans from 2020 to 2022 (Senate Majority Staff Report, 10/17/24).
$660 million
The amount of taxpayer money that CVS/Aetna stashed away in 2018 by denying Medicare Advantage patients’ claims for treatment at inpatient facilities (Senate Majority Staff Report).
78 percent
The percentage of physicians in a 2023 American Medical Association survey who said that Medicare Advantage’s prior authorization processes caused a recommended treatment for a patient to be abandoned.
$6 billion
One estimate of the amount spent in 2022 on the marketing companies that work to attract new subscribers in Medicare Advantage plans.
556,068
The number of English-language TV commercials touting Medicare Advantage that aired during the seven-week open enrollment period in 2022.
$50 billion
The amount that the Wall Street Journal estimates private insurers received between 2018 and 2021 for “hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded payments.”
$2,329
The amount that MA insurers receive per beneficiary above the estimated costs of Medicare.
$1,730
The gross profit margin posted by MA companies in 2021 – more than double their profit margin on the individual market.
$172 million
The amount that Cigna agreed to pay in 2023 to “resolve allegations that it knowingly submitted and failed to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees to increase its payments from Medicare.” The Justice Department continues to investigate similar allegations involving other MA providers.
Keep ReadingShow Less
Dems Warn of 'Rampant' Medicare Advantage Abuses as Trump's GOP Aims to Boost For-Profit Plans
"Many of these plans are a maze of prior authorization word salad designed to deny seniors the coverage they're already paying for," said Sen. Ron Wyden.
Oct 30, 2024
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."
Keep ReadingShow Less
Most Popular