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Patients, Advocates Push Biden to 'Reclaim Medicare' From Privatized Medicare Advantage
"If Medicare Advantage has it their way, they're going to deny me care and delay me care until I'm dead," said one patient.
Mar 15, 2024
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."
MA insurance companies find it financially beneficial to delay essential care to patients.
Medicare (Dis)Advantage plans take the problems of private health insurance and import them into Medicare. @PplsAction #CareOverCost pic.twitter.com/V21nKlkyLj
— Social Security Works (@SSWorks) March 14, 2024
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."
“If Medicare Advantage has it their way, they’re going to deny me care and delay me care until I’m dead.” — Jenn
The greedy health insurance corporations that run Medicare (Dis)Advantage will always put profits above patients. That’s why we’ve got to #ReclaimMedicare. pic.twitter.com/0ED1iHBu0u
— Be a Hero (@BeaHero) March 14, 2024
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."
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Biden DOJ Launches Antitrust Probe Into Medicare Advantage Behemoth UnitedHealth
"For years, UnitedHealth has unfairly and illegally leveraged each of its businesses to strategically squeeze out competitors and monopolize all corners of healthcare," said one researcher.
Feb 28, 2024
The U.S. Justice Department has launched an antitrust investigation into UnitedHealth Group, the world's largest health insurance company and a major provider of private Medicare Advantage plans that are notorious for
denying necessary care and bilking taxpayers.
The probe, first reported by The Examiner News and confirmed by The Wall Street Journal on Tuesday, drew applause from anti-monopoly campaigners who argue that healthcare industry consolidation has harmed patients through higher costs and worse care.
Matt Stoller, research director at the American Economic Liberties Project, said in a statement Tuesday that the Department of Justice is "right to investigate UnitedHealth Group for monopolization, and we hope to see enforcement action taken soon."
"For years, UnitedHealth has unfairly and illegally leveraged each of its businesses to strategically squeeze out competitors and monopolize all corners of healthcare, from insurance and pharmaceuticals to home healthcare," said Stoller. "In the process, UnitedHealth has degraded patient care, demoralized and devalued doctors and nurses, put independent pharmacies out of business, and ripped off taxpayers."
"United gained its foothold on the system through its relentless path of acquisitions."
The Examiner News reported that the DOJ notified UnitedHealth last October that it had launched a "non-public antitrust investigation into the company." According to the Journal, Justice Department investigators "have in recent weeks been interviewing healthcare industry representatives in sectors where UnitedHealth competes, including doctor groups."
Optum, a subsidiary of UnitedHealth, is the largest employer of doctors in the U.S., and the company is currently working to acquire the home healthcare provider Amedisys in a $3.3 billion deal that has drawn scrutiny from the Justice Department.
As Krista Brown and Sara Sirota wrote last year for the newsletter HEALTH CARE un-covered, "It's not hyperbole to describe UnitedHealth as the bulk of our country's healthcare system—and its $85 billion in publicly disclosed acquisition spending played a big part."
"United gained its foothold on the system through its relentless path of acquisitions," they added, "and each additional business it purchases is, and has been, used to leverage its control of the healthcare industry."
UnitedHealth is currently the nation's largest provider of privately run, publicly funded Medicare Advantage plans, which have faced growing criticism from the Biden administration and Democratic lawmakers for dramatically overcharging the federal government and denying care claims that likely would have been approved under traditional Medicare.
Last year, UnitedHealth ditched the brand name naviHealth, a technology-focused subsidiary that faced backlash after reporting by STAT detailed the company's use of artificial intelligence algorithms to deny essential care to elderly patients.
Additionally, as Brown and Sirota noted, UnitedHealth employees alleged that company executives " pressured them to deny coverage or lose their jobs," sparking a class-action lawsuit.
"In short, naviHealth was transformed from a company meant to better manage post-acute care to a machine that maximizes profits," Brown and Sirota added. "It was UnitedHealth-ified."
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UnitedHealth Touts Profit Surge After Lobbyists Weaken Medicare Advantage Crackdown
UnitedHealth CEO Andrew Witty told investors he "appreciates" the Biden administration's decision to slow the implementation of its Medicare Advantage reforms.
Apr 14, 2023
The chief executive of UnitedHealth Group told investors Friday that he "appreciates" the Biden administration's decision to more slowly implement its crackdown on overbilling in Medicare Advantage, a privately run, government-funded program that the Minnesota-based insurance behemoth touted as a key profit driver in its newly released first quarter earnings report.
UnitedHealth, one of the largest Medicare Advantage providers in the U.S., reported $91.9 billion in revenue for the first three months of 2023—15% growth year-over-year—and more than $8 billion in earnings from operations, exceeding analysts' expectations.
UnitedHealthcare, UnitedHealth Group's insurance business, "is pacing strongly to its outlook for another year of market-leading growth in serving more people through its Medicare Advantage offerings," the company said in its earnings release. The company said Friday that it added 655,000 new Medicare Advantage members in the first quarter of the year.
UnitedHealth's earnings report came after the company helped lead an aggressive lobbying campaign against new Biden administration rules aimed at limiting Medicare Advantage insurers' ability to overcharge the federal government by making patients appear sicker than they actually are.
According to The New York Times, UnitedHealth CEO Andrew Witty appeared on Capitol Hill in person to lobby against the proposed changes, which the lucrative Medicare Advantage industry falsely characterized as cuts to the program that now provides insurance to nearly half of the overall Medicare population.
Late last month, the Centers for Medicare and Medicaid Services (CMS) offered a number of concessions to the industry, agreeing to impose its policy changes over a period of three years instead of all at once and boosting Medicare Advantage payment rates by more than expected.
As STATreported last week, Wall Street investors were "overjoyed" by the Biden administration's move, which drew criticism from progressive lawmakers and healthcare analysts who warned the slow phase-in will allow Medicare Advantage plans to continue their abusive practices. UnitedHealth, like other Medicare Advantage insurers, has been accused of wrongfully denying or attempting to deny patients necessary care, in some cases utilizing artificial intelligence to determine when to end coverage.
When it comes to excess billing, CMS recently estimated that overpayments to Medicare Advantage totaled $11.4 billion in fiscal year 2022—a significant drain on the Medicare trust fund.
Citing one industry analyst, STAT noted that UnitedHealth could reap $900 million in additional profit next year alone thanks to the administration's decision to delay full implementation of the reforms.
\u201c$UNH CEO Andrew Witty says he "appreciates" @CMSGov's decision to phase in changes to Medicare Advantage risk adjustment. The delay could allow UnitedHealth to pull in at least $900 million of added profit, just next year. https://t.co/KnNbyCwqZO\u201d— Bob Herman (@Bob Herman) 1681477811
In an analysis published in February, former insurance executive Wendell Potter noted that UnitedHealth is one of just seven large for-profit insurance companies that now control 70% of the Medicare Advantage market, which is dependent on taxpayer money.
According to Potter, who now heads the Center for Health and Democracy, insurance giants UnitedHealth, Cigna, CVS/Aetna, Elevance, Humana, Centene, and Molina saw their combined revenues from taxpayer-supported programs grow 500% between 2012 and 2022.
"They've essentially been bailed out by taxpayers," Potter said of for-profit insurance giants like UnitedHealth in a recent interview with The American Prospect. "And members of Congress, and various administrations, have been just standing on the sidelines, not paying attention to what's been going on."
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