To save Medicare Advantage we must reform it

[cartoon id="274972"] Medicare Advantage, once a highly innovative and successful health care option providing unique benefit designs for older Americans, is becoming increasingly costly and unstable - and will now be under the microscope in a criminal investigation of one of its biggest players, UnitedHealth. In brief, the exploitation of Medicare Advantage by a handful of massive corporate health services conglomerates threatens to destroy the program. This is uniquely frustrating because the program is a critically needed alternative to traditional Medicare. Washington discourse has become dangerously polarized between advocates who want to abolish Medicare Advantage on one side and advocates who deny the existence of its many problems on the other. We need a middle path. If ever there were a government program in need of DOGE-like accountability, competition, and transparency, Medicare Advantage is it. In its 2024 report, the Medicare Payment Advisory Commission (MedPAC), the independent congressional agency established to advise the federal government on Medicare, found that "Medicare spends an estimated 22 percent more for Medicare Advantage enrollees than it would spend if those beneficiaries were enrolled in [fee-for-service] Medicare, a difference that translates into a projected $83 billion in 2024." Many have concluded that this excessive spending is largely due to big insurer-orchestrated fraudulent billing practices, patient coding abuses, and overcharges. Under Medicare Advantage, insurers often upcode, deny or delay care through prior authorization requests and engage in other cost-increasing behaviors. These types of actions create barriers to care, reduce plan options, and decrease medication affordability. This misuse of the Medicare Advantage system not only hurts patients, but it's financially inefficient for the government because patients remain sick for longer, leaving them continuously reliant on taxpayer-funded health care. A recent Wall Street Journal investigation found that some of the sickest patients who needed expensive treatments like nursing-home care dropped out of Medicare Advantage to switch to traditional Medicare at high rates. This suggests Medicare Advantage plans have been denying necessary coverage, leaving patients without the care they deserve and taxpayers footing the bill. This is unacceptable treatment of America's elderly and an unfair burden on taxpayers and it demands accountability and transparency. On top of these opaque practices leading to worse outcomes for patients and taxpayers is insurer-led consolidation in the healthcare system. Insurer conglomerates like UnitedHealth have gobbled up hospitals, physicians, pharmacies, and more, giving them unprecedented control over the health care system, including Medicare Advantage. Medicare Advantage is a vital program but is unsustainable without proactive reforms to rein in overpayments while boosting transparency, competition, and choice. Lasting reform means attacking the root of insurers' bad actions with clearer disclosure rules, longer notification periods before insurers or providers drop plans, and simplified plan comparison tools to prevent seniors from unknowingly enrolling in plans that don't meet their needs. Streamlining prior authorizations and their appeals process can give patients more timely access to the care they need and prevent insurers from denying care due to their own financial incentives. Medicare Advantage's promise is based on its ability to harness competition among plans to provide better coverage and care to seniors. But Congress has allowed a small cabal of mega-insurers to exploit this program, making it increasingly vulnerable to political attacks. Unfortunately, the insurance companies have enormous political influence and fiercely resist reforms. This is the industry that successfully hijacked health care debates in both Obama's Affordable Care Act and Biden's Inflation Reduction Act, both of which diverted hundreds of billions of dollars away from Medicare to unrelated spending. And UnitedHealth's $10 billion in royalties paid to AARP have given the industry a direct influence over line of communication to millions of seniors and significant influence with policymakers. Medicare Advantage can and should be a viable option for older Americans, but to save it, President Trump and Congress must take on the big insurers and reform it. And quickly. - Copyright 2025 Phil Kerpen, distributed by Cagle Cartoons newspaper syndicate. Phil Kerpen is the president of American Commitment and the author of “Democracy Denied.” Kerpen can be reached at [email protected].