Medicare Advantage under fire

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.”

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.”

In reality, so-called ‘Medicare Advantage’ is neither Medicare nor an advantage,” wrote the lawmakers, who introduced legislation that, if passed, would ban private insurance plans from using the Medicare name.

“It’s 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.

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 yearly.

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 raising eyebrows and ire.

Hundreds of advocacy groups, 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.

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.”