Republicans are proud of creating Medicare Advantage. Now some are urging reform amid runaway costs

 

 

Republicans in Congress, long an unwavering source of support for privatized Medicare plans, are increasingly calling for reforms amid widespread evidence that health insurers are abusing the system to collect billions of dollars in unwarranted payments.

 

 

The rising discontent with Medicare Advantage is especially prevalent within the GOP’s Doctors Caucus, a group of Republican congressmen who have firsthand experience treating patients covered by these plans and, in some cases, have seen how insurers manipulate the program’s rules to increase profits.

 

 

In Capitol Hill hearing rooms and interviews with STAT, some have sharply criticized insurers’ efforts to make older patients appear as sick as possible to extract more money from Medicare, a practice known as upcoding.

The changing sentiment is also driven by growing frustration over Medicare Advantage plans denying coverage for care, a point Sen. Bill Cassidy (R-La.), chair of the Senate health committee, made during a confirmation hearing last month for Mehmet Oz, who now oversees the program as the administrator of the Centers for Medicare and Medicaid Services. Republicans’ urgent need for budget savings to pay for massive tax cuts pushed by President Trump also could make Medicare Advantage a target — as its members cost the government billions more than if they were covered by traditional Medicare.

 

 

The fact that Medicare Advantage incentivizes upcoding has been recognized for almost two decades, and Democrats in Congress have long pressed for an overhaul of the $500 billion program. But the increasing buy-in from Republicans lends bipartisan support to those efforts and represents a major shift in the politics surrounding the program, which has been fiercely protected by GOP lawmakers since its initial creation in the late 1990s and a subsequent modernization passed under former President George W. Bush. Republicans argued that allowing private insurers to cover patients with the government’s money would cut costs and produce better outcomes for patients.

 

Now, some are acknowledging that insurers are taking advantage of the program. “I thought Medicare Advantage was a good thing when it came out,” Sen. Roger Marshall (R-Kan.) said during a recent hearing. “But unfortunately, it’s been manipulated.”

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