Parroting Industry Talking Points, GOP Goes to Bat for Fraud-Riddled Medicare Advantage

Since President Joe Biden accused them of wanting to cut Medicare in his nationally televised State of the Union address earlier this week, congressional Republicans have attempted to posture as the program's true defenders by touting their support for privately run plans that are riddled with fraud and abuse.

"It’s Joe Biden, NOT Republicans, who is proposing Medicare Advantage cuts," tweeted Sen. Steve Daines (R-Mont.), referring to a new payment plan that the Centers for Medicare and Medicaid Services (CMS) unveiled last week.

Under the CMS proposal, Medicare Advantage plans—which are run by private insurers and funded by the federal government—would see a payment increase of just over 1% next year.

Industry groups reacted furiously to the proposal, claiming it would actually amount to a potential $3 billion cut in Medicare Advantage payments.

According to STAT, "Medicare officials want to update data and coding systems that are used to explain the health conditions of an insurance company’s enrollees. Under that new system, insurers would not get paid as much for members with certain diagnoses."

Politico reported late Wednesday that Biden administration officials expressed confidence in their payment projections and dismissed claims of a looming cut as "cherry-picked numbers by an industry-backed group trying to protect profits."

Ahead of Biden's speech Tuesday, the Better Medicare Alliance—which counts major Medicare Advantage providers such as Aetna and Humana as "allies"—wrote in a memo to congressional lawmakers that CMS "just proposed BILLIONS in cuts to
Medicare Advantage."

"Medicare Advantage IS Medicare," the industry group wrote, a premise that critics adamantly reject. "We strongly urge President Biden and congressional leaders—Republicans and Democrats alike—to keep their promises to our seniors and protect Medicare beneficiaries."

The Coalition for Medicare Choices, a project of the powerful lobbying group America's Health Insurance Plans, also criticized the CMS proposal, warning the changes "could result in cuts to the program."

Republicans wasted no time echoing the industry's narrative, claiming that the Biden administration's new payment proposal for Medicare Advantage plans proves that the president—not the GOP—is pursuing Medicare cuts.

"The fact is, just last week the Biden administration cut Medicare programs by administrative fiat," Rep. Kevin Hern (R-Okla.), chair of the Republican Study Committee, told the right-wing Daily Caller News Foundation on Wednesday. "These cuts will impact millions of seniors.”

Hern also claimed in a tweet Wednesday that the Biden administration is "slashing nearly $5 BILLION from Medicare Advantage," an apparent reference to a new CMS rule that aims to recoup up to $4.7 billion over the next decade by ramping up audits of Medicare Advantage plans to crack down on overbilling—a common practice in the industry.

As Kaiser Health News reported in December, "The costs to taxpayers from improper payments have mushroomed over the past decade as more seniors pick Medicare Advantage plans," which are notorious for presenting patients as sicker than they actually are to get more money from the government.

"CMS has estimated the total overpayments to health plans for the 2011-2013 audits at $650 million," the outlet noted.

But mounting evidence of fraud by for-profit Medicare Advantage providers hasn't dissuaded the GOP from singing their praises and condemning oversight of them as an attack on Medicare itself.

"For Joe Biden to continue to lie and say that Republicans will cut the benefits you earned is just a gross, political lie," said Rep. Brian Mast (R-Fla.). "He's the one who just cut billions from Medicare Advantage."

"Newsflash: President Biden is cutting Medicare, not Republicans," added Rep. Vern Buchanan (R-Fla.). "Fact: He's slashing more than $3 billion from Medicare Advantage (used by over 50% of seniors) next year."

Medicare Advantage boasts significant bipartisan support in Congress and has grown rapidly in recent years, now covering roughly half of all Medicare recipients.

Beneficiaries often turn to Medicare Advantage because traditional Medicare doesn't cover dental, hearing, or vision, despite efforts by Sen. Bernie Sanders (I-Vt.) and other progressive lawmakers to expand the program.

But Medicare Advantage plans have also been found to falsely advertise their benefits and frequently deny patients medically necessary care.

"Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program," The New York Times reported last year, citing findings from the inspector general's office of the Health and Human Services Department.

Earlier this month, as Common Dreams reported, Reps. Mark Pocan (D-Wis.), Ro Khanna (D-Calif.), and Jan Schakowsky (D-Ill.) reintroduced legislation that would change the name of Medicare Advantage to make clear that the plans are run by for-profit insurers.

"Medicare Advantage is private insurance," Khanna wrote in a social media post on Sunday. "It profits by tricking patients into enrolling, and then denying them coverage."