As Scandals Mount, So Do Calls to Abolish Private Medicare Advantage Plans

As yet another scandal involving Medicare Advantage made headlines this week, progressive U.S. lawmakers and advocates renewed calls to abolish the private health insurance program that a recent Senate report said is “running amok” with “fraudsters and scam artists.”

“In reality, so-called ‘Medicare Advantage’ is neither Medicare nor an advantage.”

In a new Nation article written with health insurance reform advocate Wendell Potter, Reps. Ro Khanna (D-Calif.) and Mark Pocan (D-Wis.) contend that one of the most confusing things facing elders while choosing their Medicare plans “is a scheme by private insurance companies to prey on seniors and profit off of the Medicare brand, all in the name of padding their corporate profits and shareholder returns.”

“The scheme is called Medicare Advantage. But in reality, so-called ‘Medicare Advantage’ is neither Medicare nor an advantage,” wrote the lawmakers, who earlier this year introduced legislation that, if passed, would ban private insurance plans from using the Medicare name.

“It’s actually just private insurance that uses the trusted Medicare name to trick seniors and people with disabilities into enrolling, then profits by denying coverage for necessary medical care,” Khanna and Pocan added. “It is long past time for Congress to end this scam and ensure that consumers get accurate information about their healthcare options.”

On Monday, Kaiser Health News detailed how insurance companies selling Medicare Advantage plans “have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.”

The KHN report said that government auditors “uncovered millions of dollars in improper payments—citing overcharges of more than $1,000 per patient a year on average—by nearly two dozen health plans.”

This follows a Senate Finance Committee report published last month that found insurance companies and other brokers are making false or misleading claims to dupe senior citizens into purchasing Medicare Advantage plans.

An investigation published in October by The New York Times found that insurance companies are exploiting Medicare Advantage plans to rake in billions of dollars in excess profits.

In April, the inspector-general’s office at the U.S. Department of Health and Human Services published a report revealing that Medicare Advantage plans deny medically necessary care to tens of thousands of enrollees each year.

Nearly half of Medicare’s 60 million beneficiaries are currently enrolled in Medicare Advantage plans, and the majority of U.S. seniors are expected to be signed up by next year.

The ACO-REACH program, a Trump-era scheme set to take effect on January 1st that would shift some Medicare recipients to private insurance plans without their knowledge or consent, is also raising eyebrows and ire.

Hundreds of advocacy groups, as well as the Arizona Medical Association, the Seattle City Council, the Texas State Democratic Executive Committee, and the Austin AFL-CIO Council have called on the Biden administration to end ACO-REACH.

Common Dreams reported Monday that 21 progressive lawmakers led by Sen. Elizabeth Warren (D-Mass.) and Rep. Pramila Jayapal (D-Wash.) urged Centers for Medicare and Medicaid Services Administrator Brooks-LaSure to investigate ACO-REACH, which the signers said “provides an opportunity for healthcare insurers with a history of defrauding and abusing Medicare and ripping off taxpayers to further encroach on the Medicare system.”