Source: United States House of Representatives – Congresswoman Pramila Jayapal (7th District of Washington)
WASHINGTON – U.S. Representatives Pramila Jayapal (WA-07), Rosa DeLauro (CT-03), and Jan Schakowsky (IL-09), and Lloyd Doggett (TX-37) are leading 74 lawmakers in calling on the Centers for Medicare and Medicaid Services (CMS) to enact urgent reforms to Medicare Advantage (MA) plans. As the Trump administration and Elon Musk look for ways to cut fraud and wasteful spending, corporate MA plans should be a major target to save billions each year.
Unlike Traditional Medicare, MA plans are administered by private insurers and have been found to be fraught with waste and abuse while sacrificing patient outcomes for higher corporate profit and threatening the overall solvency of Medicare.
“Initially promoted as a way to save taxpayer dollars and improve quality of care, the Medicare Advantage program has continuously cost more than if the same enrollees were covered by Traditional Medicare and has not improved health outcomes. We strongly urge you to rein in the wasteful and harmful practices committed by corporate health insurers in MA,” wrote the Members.
The private insurance companies running MA plans mislead the public by claiming their plans save money and improve care. However, private insurers in MA overcharged CMS by at least $83 billion in 2024 without any improvements to the quality of care for patients. These overpayments to private insurers threaten the stability of the entire Medicare program for the 65 million Americans who rely on it.
“At a time when Americans are paying nearly $26,000 per family in premiums per year, while the largest US insurer made $23 billion in annual profits, reining in profiteering could not be more important,” continued the Members.
The Members are specifically calling on CMS and the Department of Health and Human Services to take the following actions:
- Eliminate waste and abuse from overpayments by improving risk adjustment calculations in the proposed 2026 Medicare Advantage Rate Notice;
- Strictly enforce the overpayment regulations for Medicare Advantage Organizations outlined in the 2025 Medicare Physician Fee Schedule rule;
- Strengthen enforcement against MA insurers that illegally deny care;
- Address additional barriers to care, including by enforcing statutory requirements compelling insurers to disclose the methodology behind algorithms used for coverage decisions, and;
- Enact reforms to reduce disparities in care.
“We cannot continue to allow Medicare Advantage to be a source of profit for greedy companies and suffering for seniors and people with disabilities. Medicare Advantage has never delivered on the promise of actually lowering the cost or improving the quality of care,” said Eagan Kemp, Health Care Policy Advocate for Public Citizen. “In the short term, there must be enhanced oversight of the Medicare Advantage program to ensure enrollees get the care they need and bring down unnecessary overpayments. In the long run, we must improve and expand traditional Medicare to guarantee it is around for decades to come.”
“Every day in my work as a gynecologic oncologist, I witness the harms inflicted on my patients by the profit-driven Medicare Advantage plans they were forced into by economic circumstances or their retirement plans. Care delays and denials decrease their chances of cancer cure and lead to needless suffering and hours of wasted healthcare provider time,” said Dr. Diljeet K. Singh, M.D., DrPH, PNHP President. “I urge all members of Congress to fight for your constituents by taking the actions outlined in this letter to “Eliminate waste and abuse from overpayments, strengthen enforcement against MA insurers that illegally deny care, address additional barriers to care, and enact reforms to reduce disparities in care.” Please support this effort to protect the health of all Medicare enrollees, extend the solvency of the Medicare Trust Fund, and curb billions in taxpayer overpayments driven by for-profit insurers.”
“Medicare Advantage is a failed experiment. It has failed to reduce the cost of delivering quality care and it fails patients when they are sick and need it the most. What Medicare Advantage is doing very well is siphoning precious public funds into private corporate coffers by denying patient care and overcharging the government,” said Dr. Jamila Headley, Be A Hero Executive Director. “Patients in this country are in an incredibly bleak moment as tens of millions of Americans face the impact of devastating cuts to our public health programs, as Republicans in Congress propose hundreds of billions of dollars in cuts to Medicaid, and as the administration mulls over the implementation of Project 2025 plans to make Medicare Advantage the default enrollment option. This is not what the American people want and it will surely make us sicker.”
The letter is cosigned by Alma Adams (NC-12), Yassamin Ansari (AZ-03), Becca Balint (VT-AL), Wesley Bell (MO-01), Donald Beyer (VA-08), Salud Carbajal (CA-24), André Carson (IN-07), Greg Casar (TX-35), Kathy Castor (FL-14), Joaquin Castro (TX-20), Sheila Cherfilus-McCormick (FL-20), Judy Chu (CA-28), Gilbert Cisneros (CA-31), Yvette Clarke (NY-09), Emanuel Cleaver (MO-05), Steve Cohen (TN-09), Danny Davis (IL-07), Christopher Deluzio (PA-17), Mark DeSaulnier (CA-10), Debbie Dingell (MI-06), Maxwell Frost (FL-10), John Garamendi (CA-08), Jesús García (IL-04), Robert Garcia (CA-42), Sylvia Garcia (TX-29), Daniel Goldman (NY-10), Al Green (TX-09), Val Hoyle (OR-04), Jared Huffman (CA-02), Glenn Ivey (MD-04), Jonathan Jackson (IL-01), Henry Johnson (GA-04), Robin Kelly (IL-02), Ro Khanna (CA-17), Raja Krishnamoorthi (IL-08), Greg Landsman (OH-01), George Latimer (NY-16), Summer Lee (PA-12), Teresa Leger Fernandez (NM-03), Zoe Lofgren (CA-18), Betty McCollum (MN-04), James McGovern (MA-02), LaMonica McIver (NJ-10), Grace Meng (NY-06), Kweisi Mfume (MD-07), Jerrold Nadler (NY-12), Eleanor Holmes Norton (DC), Alexandria Ocasio-Cortez (NY-14), Ilhan Omar (MN-05), Chellie Pingree (ME-01), Mark Pocan (WI-02), Ayanna Pressley (MA-07), Mike Quigley (IL-05), Delia Ramirez (IL-03), Emily Randall (WA-06), Luz Rivas (CA-29), Patrick Ryan (NY-18), Mary Gay Scanlon (PA-05), Robert Scott (VA-03), Brad Sherman (CA-32), Lateefah Simon (CA-12), Adam Smith (WA-09), Mark Takano (CA-39), Shri Thanedar (MI-13), Bennie Thompson (MS-02), Mike Thompson (CA-04), Rashida Tlaib (MI-12), Jill Tokuda (HI-02), Paul Tonko (NY-20), Lauren Underwood (IL-04), Nydia Velázquez (NY-07), Maxine Waters (CA-43), Bonnie Watson Coleman (NJ-12), and Nikema Williams (GA-05).
It is also endorsed by Just Care USA, Social Security Works, Families USA, Consumers Council of Missouri, Physicians for a National Health Program, People’s Action, Center for Health Progress, Center for Health and Democracy, The People’s Lobby, MoveOn, National Nurses United, Progressive Maryland, Center for Medicare Advocacy, National Health Care for the Homeless Council, Citizen Action of Wisconsin, Connecticut Citizen Action Group (CCAG), Physicians for a National Health Program of Minnesota, Public Citizen, Be A Hero, Progressive Democrats of America (PDA), PSARA (Puget Sound Advocates for Retirement Action), Healthcare NOW, United Electrical, Radio & Machine Workers of America (UE), Michigan United, International Federation of Professional and Technical Engineers (IFPTE), and Citizen Action of New York.
The full text of the letter can be read here.
Issues: Health Care