Schakowsky, Doggett, & Jayapal Lead Colleagues in Urging Reform of Medicare Advantage to Protect Taxpayer Dollars & Improve Care

WASHINGTON – Congresswoman Jan Schakowsky (D-IL), Co-Chair of the Task Force on Aging & Families, Congressman Lloyd Doggett (D-TX), Chair of the House Ways & Means Health Subcommittee, and Congresswoman Pramila Jayapal (D-WA), Chair of the Congressional Progressive Caucus, led over 30 Members in responding to the Centers for Medicare & Medicaid Services (CMS) Request for Information on the Medicare Advantage (MA) program. Taxpayers spend an average of $1,538 more per beneficiary in Medicare Advantage than would have otherwise been spent by Traditional Medicare—amounting to $12 billion in overpayments in a single year. Despite this significant cost, regulators have received numerous complaints regarding access to care and quality of coverage under MA. The Members urge significant reforms to prevent delays and medically unnecessary restrictions on access to care, rein in aggressive marketing tactics, reduce waste of billions of taxpayer dollars in overpayments, and to terminate the ACO REACH program, which unwillingly places beneficiaries in arrangements similar to Medicare Advantage.

"I am extremely concerned about Medicare Advantage plans and their deceitful practices. That is why I am proud to co-lead this comment letter to the Centers for Medicare and Medicaid Services (CMS). Seniors deserve comprehensive health care," said Congresswoman Jan Schakowsky. "During a hearing in House Energy and Commerce Subcommittee on Oversight & Investigations, we learned that Medicare Advantage (MA) plans are deceitfully making seniors seem sicker than they are so plans can line their own pockets. We know that these ‘upcoding' practices accounted for $12 billion in additional payments to MA plans. This is happening all while the same MA plans use delays and coverage denials to prevent seniors from accessing much-needed care. This must end now. I am committed to ensuring oversight over these bad actors and urge CMS to quickly implement our recommendations. Seniors deserve better!"

"The promise of Medicare for American seniors and individuals with disabilities is for comprehensive, affordable, and quality health care—not for taxpayers to consistently pay more and more for less and less care," said Congressman Lloyd Doggett. "For roughly two decades, Medicare Advantage has misled consumers, imposed medically unnecessary and sometimes dangerous obstacles to receiving care, and endangered Medicare's fiscal future. The Biden Administration should promptly implement substantial reforms to advance patient health and protect the health of Medicare."

"For too long, Medicare Advantage has put profits over the proper care of our seniors," said Congresswoman Pramila Jayapal. "Our letter outlines the steps CMS can take—from stopping overpayments to Medicare Advantage plans, which waste billions of taxpayer dollars, to stopping the care delays and denials through Medicare Advantage's prior authorization scam—for Medicare Advantage to finally begin working for patients again. We urge CMS to implement these fixes right away. Our seniors can't afford to wait."

The Members write: "Too often, Medicare Advantage plans deny, delay, or prematurely terminate medically necessary health care that would have been covered under Traditional Medicare." They continue: "Ultimately, many beneficiaries disenroll from Medicare Advantage, with sicker patients disenrolling at a disproportionately higher rate."

Further, they note: "There is consistent and growing evidence that the Medicare Advantage program is paid more than Traditional Medicare would spend on the same beneficiary, and such spending is growing per person, with significant implications for Medicare's long-term solvency."

Their full letter can be found here.

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