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medicare
A $1.2 Trillion ‘Rip Off’: Report Spotlights Massive Scale of Medicare Advantage Fraud
"These private insurer-run plans are more expensive AND lead to worse outcomes for patients," said Rep. Pramila Jayapal. "It’s time to rein in Medicare DisAdvantage and protect traditional Medicare."
Jan 28, 2026
A report released earlier this month to little fanfare estimated that federal overpayments to privately run Medicare Advantage plans could total $76 billion this year—or potentially a staggering $1.2 trillion over the next decade if current trends persist.
The Medicare Payment Advisory Commission (MedPAC), an independent congressional agency that advises lawmakers on Medicare, calculates overpayments by comparing spending on Medicare Advantage (MA) plans to what the federal government would have spent if MA enrollees were on traditional fee-for-service Medicare.
In a report published earlier this month, MedPAC showed that overpayments to MA plans this year are projected to be around $76 billion. Roughly $22 billion of that total is due to coding practices by MA providers, which are notorious for making patients appear sicker than they are to receive larger payments from the federal government. MA plans are paid lump sums to cover expected future healthcare services for patients based on their risk scores.
Another factor driving overpayments to MA plans—which now cover 55% of eligible Medicare beneficiaries—is a phenomenon known as favorable selection. MA enrollees tend to be healthier on average than recipients of traditional Medicare, resulting in higher payments to Medicare Advantage plans than are necessary based on patients' healthcare needs.
According to MedPAC, favorable selection will account for $57 billion of the expected overpayments to MA plans this year. The Trump administration gave Medicare Advantage plans a more than $25 billion boost in federal payments for 2026, even amid mounting bipartisan concerns about fraud in the program.
The National Committee to Preserve Social Security and Medicare (NCPSSM) said the MedPAC analysis "confirms that these private plans are bleeding taxpayers for billions of dollars more than traditional Medicare would cost for comparable enrollees."
US Rep. Pramila Jayapal (D-Wash.) wrote in response to the MedPAC findings that "Medicare DisAdvantage will rip off American taxpayers to the tune of $76 billion in 2026."
"These private insurer-run plans are more expensive AND lead to worse outcomes for patients," Jayapal, a leading supporter of Medicare for All legislation in the House, wrote in a social media post. "It’s time to rein in Medicare DisAdvantage and protect traditional Medicare."
The MedPAC analysis was released days after Republicans on the Senate Judiciary Committee published a report revealing how UnitedHealth Group, the largest provider of MA plans in the US, "has turned risk adjustment into a major profit-centered strategy," reaping massive payments from the federal government through upcoding.
NCPSSM noted that "while UnitedHealth... has emerged as the worst offender, it’s abundantly clear that many MA insurers are engaged in these shady practices."
"Look no further than insurers’ reliance on prior authorizations for procedures and treatments that normally would be automatically covered in traditional Medicare," the group said. "This includes denying skilled nursing care that jeopardizes older patients who have nowhere else to turn."
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Trump's Health Plan Is Doomed to Fail—We Need Medicare for All
Unsurprisingly, Trump’s concepts of a plan don't even begin to reverse the damage he caused when he made massive cuts to Medicaid and the Affordable Care Act in order to fund tax cuts for billionaires.
Jan 17, 2026
President Donald Trump’s new “Great Health Care Plan” is anything but.
Unsurprisingly, Trump’s concepts of a plan fail to even begin to reverse the damage he caused when he made massive cuts to Medicaid and the Affordable Care Act in order to fund tax cuts for billionaires. Now, Trump and his Republican allies are trying to cover up the gaping wound they have created with a Band-Aid. At the same time, Americans are desperate for relief from Trumpflation, including rapidly rising healthcare costs.
Too many Americans struggle to get the healthcare they need even with insurance. A recent poll found that more than 1-in-3 adults in the US had skipped or postponed needed healthcare in the last 12 months because they couldn’t afford the cost. The situation is even more dire for the uninsured, with 75% of uninsured adults under age 65 reporting going without needed care because of the cost.
Shutdown negotiations and subsequent scattershot health ideas from the White House and Republicans in Congress show they have no real idea what to do when it comes to actually bringing down the cost of healthcare in America. President Trump’s half-baked plan appears doomed to fail and doesn’t even have the support of Republicans in Congress. Plus the only alternate Republican plans for healthcare that currently exist strictly serve corporations and fail to provide relief to patients.
Every other comparably wealthy country has some version of universal healthcare, and none of them would trade their systems for the wasteful and haphazard US system.
Meanwhile, the Trump administration has undertaken efforts to further privatize Medicare, including adding Medicare Advantage-style prior authorization to traditional Medicare, risking access to care for seniors by delaying and denying needed care. It also plans to place Medicare enrollees in private health contracts, similar to Medicare Advantage, where the corporations in charge are incentivized to place corporate profits ahead of patient needs.
Americans are angry about our broken healthcare system, and they want a comprehensive solution. One recent survey found that 65% of voters support a Medicare for All-style system. A similar number of voters said that the federal government right now does too little to ensure Americans can afford the healthcare they need. An in-depth study that looked across four years of data found that more than a quarter of adults went without needed care or experienced cost burdens for care they did receive over the four-year period of the study. The high cost of care and limited coverage leaves tens of millions of Americans without adequate coverage, and millions of them end up saddled with medical debt, something unheard of in other comparably wealthy countries. We need to take bold but commonsense action to finally guarantee that everyone in the US can get the healthcare they need.
Providers and hospitals are also desperate for reform. The cost of doing business in our broken healthcare system is causing hospitals to close or shutter crucial services. Providers are facing huge challenges as greedy profiteers, including private equity companies, gobble up their hospitals and medical practices and impose cost-cutting measures in the service of maximizing profits.
Fortunately, Medicare for All would address all of these issues and finally put the health of Americans ahead of corporate profits. Medicare for All would guarantee that everyone in the US can get the care they need when they need it, without financial barriers or hoops to jump through, and would be cheaper than our current system while providing coverage that is better than any commercial health insurance plan. It would do this by taking Medicare—one of the most popular parts of our healthcare system—improving it by expanding available services, ending out-of-pocket costs, and expanding it to everyone in the country.
Corporations and certain members of Congress purposefully make such a commonsense system sound like an impossible leap from America’s current broken system in order to stifle American dissatisfaction with our healthcare and keep shareholders happy. But every other comparably wealthy country has some version of universal healthcare, and none of them would trade their systems for the wasteful and haphazard US system.
We continue to see more members of Congress signing on to support Medicare for All in both the House and the Senate, and more municipalities supporting resolutions in favor of Congress passing Medicare for All. The time has come to unite around Medicare for All and build the movement that can finally make it a reality.
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It's Obvious the US Healthcare System Isn't Working, So Why Not Try Medicare for All?
In a moment when the boundaries of what is “reasonable” or “possible” have been completely blown open, universal healthcare no longer seems so unrealistic.
Dec 18, 2025
Between the (likely) expiration of the Affordable Care Act enhanced subsidies, cuts to Medicaid and Medicare, and the decade-long efforts to undermine and dismantle the ACA, the casualties and costs of our current healthcare system continue to grow as Americans continue to wait for a better option. Nearly 45,000 Americans aged 17-65 die each year due to lack of insurance, a number that could rise to over 51,000 preventable deaths in the coming years.
Yet, the Senate has failed to pass either healthcare plan proposed to keep health insurance premiums from skyrocketing in the New Year and the Medicare for All bill introduced by Sen. Bernie Sanders (I-Vt.) and US Reps. Pramila Jayapal (D-Wash.) and Debbie Dingell (D-Mich.) in April 2025 has not advanced in Congress. Ideas like Medicare for All or universal healthcare often make eyes roll. “That’s unrealistic,” we’re told.
But is it? Universal healthcare is, after all, the reality for most other high-income countries. And yes, it might be disruptive, but Americans have lived through unprecedented changes and significant events in the past five years: the Covid-19 pandemic, the January 6 insurrection, and the rapid development of generative AI. Throughout history, major healthcare reforms have been born from disruption; Medicare is rooted in the civil rights movement, and the ACA passed in the wake of the 2008 financial crisis.
Now, as the United States prepares to celebrate its 250th anniversary, our foundational rights and institutions are being tested in ways that once would have been unthinkable. In a moment when the boundaries of what is “reasonable” or “possible” have been completely blown open, universal healthcare no longer seems so unrealistic.
Do we accept being the only high-income country where getting sick can cost you your home, your job, or your life?
We certainly can’t continue as we’ve been going. As a nurse scientist and postdoctoral fellow, I have a front-row seat to the healthcare crises we are facing: unaffordable medical bills, growing healthcare costs, long waits for specialty and even primary care appointments, and the growing burden of chronic illness and mental health crises. Employers are now shifting employees into high-deductible plans with high out-of-pocket costs. People are effectively locked into jobs they cannot leave because losing coverage, even temporarily, can be a significant financial risk—especially for those covering spouses and children.
We have extensive evidence, both internationally and within the US, showing what strategies produce better results. Any meaningful reform should include:
- Universal population coverage: Federal requirements must guarantee that every person living in the US has insurance that covers necessary healthcare services, including primary care, specialty care, mental health, reproductive health, preventive care, and hospitalizations.
- Care that is free or affordable: A largely single-payer financing model like Canada, Australia, and most high-income countries (as proposed in the “Medicare For All” bill) or a hybrid public-private system, where private insurance is still available but federally regulated to ensure cost containment, limit out-of-pocket costs, and eliminate catastrophic medical expenses, protecting families from significant medical debt.
- A focus on prevention and primary care: Meaningful investment in preventive services, primary care, and care coordination to reduce costs, prevent unnecessary emergency room visits and hospitalizations, and improve long-term health.
But people remain skeptical that we can achieve these goals in the US—largely because of public opinion and political will, both of which are significantly influenced by private health corporations, including insurance companies, large hospital systems, pharmaceutical companies, and other obscure middlemen that profit from the status quo.
For decades these corporations have spent hundreds of millions of dollars lobbying Congress and advertising to the public to protect their revenue and discourage solutions that most of us agree with and would benefit from. President Donald Trump himself criticized health insurers as “money-sucking,” calling them “BIG BAD insurance companies.” If policymakers on both sides of the aisle agree that corporate interests are getting in the way of healthcare reform, why do we continue to defer to them?
Opponents of single-payer, universal healthcare cite the costs, but the US already spends more on healthcare than other high-income countries with universal healthcare—and better health outcomes. It is expensive to maintain a broken system.
Major change is challenging but not impossible. Most Americans are dissatisfied with the costs, shortcomings, and complexities of our current healthcare system and support the idea of universal healthcare. We have the resources, expertise, and innovation to create a healthcare system that works for everyone. What we have not yet shown is the courage to do it.
As the country approaches its 250th anniversary, we should be asking what kind of nation we want to be. Do we accept being the only high-income country where getting sick can cost you your home, your job, or your life? Or do we finally build a system that treats healthcare as a public good rather than a commodity?
If the president really wants to “make America Healthy Again,” he can—through real healthcare reform. And for the rest of us, instead of just waiting to see what happens with the ACA subsidies, we can all work to build broad coalitions and support politicians who have a bold vision for healthcare and the courage to actually make a change.
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