Source: United States House of Representatives – Congressman Lloyd Doggett (D-TX)
Washington, D.C.—Today, U.S. Representative Lloyd Doggett (D-TX), Ranking Member of the House Ways & Means Health Subcommittee, joined by 44 colleagues, introduced the Saving Medicare Enrollees from Deceptive Insurers and Creating Ample Resources for Everyone (Saving MEDICARE) Act. This landmark legislation comprehensively addresses the many ways Medicare Advantage insurers are overpaid—with a consistent goal of leveling the playing field so that Traditional Medicare does not remain at a disadvantage to giant private insurance companies.
“Despite their early claims of greater efficiency and lower costs, Medicare Advantage has never saved a penny. It actually costs taxpayers more each year while offering consumers less. This unjustified, costly advantage private Medicare Advantage insurers receive must be ended to save taxpayers and end the disadvantage for Traditional Medicare,” said Rep. Doggett. “As the Trump regime jeopardizes the promise of comprehensive health care for retirees and the disabled, the Saving MEDICARE Act will provide essential resources to achieve better Medicare for more Americans.
“Medicare Advantage insurers have been getting away with robbing the American people for far too long. The Saving MEDICARE Act would finally start to level the playing field between Medicare Advantage and Traditional Medicare by preventing insurer payment shenanigans and enhancing oversight of insurers,” said Robert Weissman, Co-President of Public Citizen. “If we don’t take action now, we are on course to waste more than $2.5 trillion over the next decade in overpayments to Medicare Advantage plans, which not only cost more than Traditional Medicare but which also make patients and providers jump through unnecessary hoops, including delays and denials of necessary care. The time has come to put patients ahead of profits and pass this commonsense legislation that will not only save taxpayers money but will help ensure that the Medicare program is on firm financial footing for the future.”
“The Saving MEDICARE Act would be an important first step towards righting the Medicare ship and strengthening the traditional Medicare program” said David Lipschutz, Co-Director of the Center for Medicare Advocacy. “Reining in wasteful overpayments to Medicare Advantage plans and enhancing oversight of this private market would provide needed stability to Medicare’s finances, as well as a real opportunity to enhance the Medicare program – to the benefit of all enrollees – by expanding the scope of coverage (such as dental, hearing and vision) and reducing out-of-pocket costs (such as capping such expenses).”
“Medicare Advantage is neither Medicare nor an advantage. It is simply another mechanism Big Insurance uses to pad their profits with taxpayer dollars while the majority of Americans continue to struggle with skyrocketing health care costs. Congress should act to end the abusive and predatory actions of Big Insurance and Congressman Doggett’s legislation is an important step to do that. We urge Congress to pass it without delay.” – Rachel Madley, Executive Director, Center for Health and Democracy
Medicare Advantage has remained much more expensive than Traditional Medicare—with the nonpartisan, independent Medicare Payment Advisory Commission (MedPAC) estimating MA will cost $2,660 more per enrollee in 2026. MA insurers use a variety of tactics to secure additional payments, including upcoding to make patients appear sicker, and favorable selection to steer healthy consumers into MA plans and sicker patients into Traditional Medicare. Flawed program design and inadequate oversight and enforcement has also resulted in overpayments.
The Saving MEDICARE Act would:
- Prevent upcoding by:
- Excluding diagnosis codes collected from chart reviews and health risk assessments, as recommended by MedPAC.
- Requiring CMS to review diagnosis codes annually as part of the Medicare Advantage payment rulemaking, and eliminate or adjust codes that are most likely to be abused.
- Prohibiting percentage of premium contracts and other financial incentives for providers to add unnecessary diagnosis codes, as recommended by the Center for American Progress.
- Creating a MedPAC study on establishing an alternative risk adjusted payment system based on consumer survey data, as recommended by the Center for American Progress.
- Improve benchmark payments by:
- Establishing a favorable selection payment adjustment, as recommended by the Center for American Progress.
- Eliminating the county quartile system, as recommended by MedPAC.
- Eliminate frivolous payments by:
- Ending the failed Quality Bonus Program, as recommended by the Medicare Rights Center.
- Permitting the VA to collect reimbursement from MA plans for care delivered to dually-enrolled veterans, just as the VA already does with other commercial insurance. This is supported by the American Legion, Veterans of Foreign Wars, Paralyzed Veterans of America, and other consumer groups.
- Enhance oversight by:
- Establishing timelines for completion of Risk Adjustment Data Validation (RADV) audits and requiring plans to help finance audits, as recommended by the Center for American Progress.
- Permitting state insurance commissioners to enter into agreements with CMS to share enforcement authority over Medicare Advantage plans, as recommended by the National Association of Insurance Commissioners.
Watch Congressman Doggett introduce the legislation on the House floor here.
The bill text can be found here and a fact sheet can be found here.
A 10-year savings estimate of $2.5 trillion from the Brown University Center for Advancing Health Policy through Research (CAHPR) can be found here.
Endorsing organizations include Public Citizen, Families USA, Center for Medicare Advocacy, Medicare Rights Center, National Committee to Protect Social Security and Medicare, Justice in Aging, Center for Health and Democracy, Social Security Works, Healthcare NOW
Original Cosponsors: Reps. Ansari, Balint, Carson, Casar, Chu, Clarke, Cleaver, Cohen, Danny Davis, DeLauro, Deluzio, DeSaulnier, Dingell, Garamendi, C. Garcia, R. Garcia, Green, Grijalva, Huffman, Jackson, Jayapal, H. Johnson, Khanna, McGovern, Mfume, Nadler, Norton, Ocasio-Cortez, Omar, Pingree, Pocan, Ramirez, Randall, Schakowsky, B. Scott, Smith, Takano, Thanedar, B. Thompson, Tlaib, Tokuda, Velazquez, Waters, Watson Coleman
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