SUBSCRIBE TO OUR FREE NEWSLETTER
Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
5
#000000
#FFFFFF
5
#000000
#FFFFFF
medicare advantage
Celebrate Medicare and Medicaid—and Protect Them From Trump!
Trump and his allies in Congress have not so much dismantled these programs yet as chipped away at them; if this movement continues unabated, we may be left with the crumbling foundations of programs that were built to last.
Jul 30, 2026
There is reason to celebrate Medicare and Medicaid turning 61 years old. Both highly successful programs were signed into law by President Lyndon B. Johnson on July 30, 1965 as a cornerstone of his Great Society agenda. But this year, our celebration is tempered by grave concern over the future of both programs under the Trump regime.
Let’s compare the words of the two presidents:
LBJ:
No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents.
It’s not possible for us to take care of… Medicaid, Medicare, all these individual things. They can do it on a state basis. You can’t do it on a federal. We have to take care of one thing: military protection. We have to guard the country.
The comparison speaks volumes. One is a leader who understood that the federal government has a crucial role in the protecting the health and well-being of our most vulnerable citizens—including the poor, disabled, and the elderly. The other is a president who claims to support Medicare and then says that the federal government can’t afford it because of his illegal war in Iran. So much for supporting Medicare.
But this goes deeper than Trump’s rhetoric. The Medicare program, like Social Security, is at a pivotal point in its history. The Part A hospital) trust fund must be fortified so that it doesn’t run dry in the 2030s. (There are reasonable solutions that Congress could enact without hurting seniors.) So far, though, we have heard no constructive ideas from Trump.
More urgently, though, the Trump administration is actively undermining the "traditional Medicare" program that LBJ signed into law. The administration has begun a pilot program to use AI bots to determine whether traditional Medicare patients will be covered for procedures their doctors have ordered. This appears to be an attempt to cut costs by erecting obstacles to medically necessary care—with decisions made by bots instead of human beings.
It could be the first step in a scheme to corrupt traditional Medicare and make it more like the privatized Medicare Advantage program run by for-profit insurers, which is a glorified HMO (with frequent denials of care, limited provider networks, and surprise out-of-pocket costs for beneficiaries). Unfortunately, thanks to deceptive but pervasive advertising, Medicare Advantage has now captured more than 51% of the market, leaving traditional Medicare with a shrinking share of enrollees.
The problem is that Medicare Advantage (MA) puts profits over patients. Participating insurance companies have been overbilling the federal government by billions of dollars a year. Ironically, this privatized program was supposed to save taxpayers money. Instead, Medicare Advantage plans cost the government an average of 14% more per patient than traditional Medicare. That translates into an additional $76 billion in federal spending this year alone.
The bottom line: Medicare Advantage puts taxpayers’ money into the hands of large insurance companies while failing to deliver superior or more cost-effective care. It is fair to say that this is not what LBJ had in mind when he created the public Medicare program. (Medicare Advantage arrived—in nascent form—in 1997, after considerable pressure from the insurance industry.)
When we talk about the financial shortfall facing the Medicare program, we must look at Medicare Advantage as an aggravating factor. Reining-in MA would go a long way toward restoring the overall program to fiscal health—along with other commonsense reforms. Unfortunately, the Trump administration has been inconsistent on this issue, initially floating strict curbs on MA overpayments but ultimately rewarding insurance companies with higher payouts.
Traditional Medicare is far from perfect. It should have caps on patients’ out-of-pocket medical costs. It should cover vision, dental, and hearing care. (President Joe Biden attempted to expand coverage in the ill-fated Build Back Better Act.) These are improvements that we have long urged Congress and the White House to enact.
Medicare also faces compound financial challenges—including the overall rise in healthcare costs and soaring prescription drug prices. The Biden administration and Democrats in Congress took a major step in the right direction with the Inflation Reduction Act, which empowered Medicare to negotiate drug prices with Big Pharma. This process is expected to save the government more than $230 billion by 2031.
For the most part, the Trump administration has adhered to the law and continued negotiating with drugmakers—but it also expanded the list of cancer drugs that won’t be eligible for negotiations. The president has largely relied on smoke and mirrors to make it appear that the administration is "tough on Big Pharma," using gimmicks like TrumpRx. Meanwhile, in a move that will make medications less affordable for seniors, the Trump administration has just announced it is ending Biden-era subsidies in the Medicare Part D prescription drug program.
Of course, it’s also Medicaid’s 61st anniversary. The damage that Trump and the Republicans have done to Medicare’s sister program would take up another entire article. Suffice it to say that more than 3 million Americans have already lost health coverage since Trump and the GOP enacted their Big, Ugly Bill, which slashed nearly $1 trillion from Medicaid. (This also hurts older people dually enrolled in both Medicare and Medicaid.) It was correctly labeled the biggest cut in healthcare in US history—to pay for tax cuts largely benefiting the wealthy.
The political right has always been wary of the New Deal and Great Society legacy programs that lifted people out of poverty and provided older and lower-income Americans with basic retirement and health security. Some on the right have outright committed themselves to dismantling these programs, despite their distinguished histories. Trump and his allies in Congress have not so much dismantled these programs yet as chipped away at them under the guise of fighting "fraud and abuse." If this movement continues unabated, we may be left with the crumbling foundations of programs that were built to last, for the good of the American people.
Keep ReadingShow Less
Trump Weighs Ultimate Gift to For-Profit Insurance Industry: Medicare Privatization
"They want to remove the guarantee of Medicare," one advocate said of the Trump administration's floated plan to automatically enroll seniors in Medicare Advantage.
Apr 10, 2026
The Trump administration is considering enacting a policy that would automatically funnel seniors into for-profit Medicare Advantage plans—which critics say would set Medicare on the path to full-scale privatization.
Chris Klomp, the Trump administration's director of Medicare and deputy administrator of the Centers for Medicare and Medicaid Services (CMS), told STAT last month that enrolling seniors in Medicare Advantage (MA) plans by default "is something that we're thinking through." MA plans are funded by the federal government and run by private insurance companies such as UnitedHealthcare and Humana, both of which have been accused of improperly denying necessary care to patients and overcharging taxpayers.
The default enrollment scheme was floated in the far-right Project 2025 agenda that President Donald Trump has repeatedly tried to disavow. Currently, older Americans who have received Social Security benefits for at least four months before they turn 65 are automatically enrolled in traditional Medicare, and they can choose to enroll in an MA plan as an alternative.
"Another bad idea straight from Project 2025," Rep. Mark Pocan (D-Wis.) said in response to Klomp's comments on the proposed default enrollment change. "Medicare Advantage is private, for-profit insurance that overcharges American taxpayers by billions every year and regularly denies seniors the care they need."
"Making Medicare Advantage the default option hurts patients and taxpayers," Pocan added, "but it will make insurance execs a lot of money."
"With Mehmet Oz running the agency, they can move incredibly quickly to make that happen, and they are."
Klomp said no plans have been finalized, but defenders of traditional Medicare warned that CMS—headed by Mehmet Oz, who during his 2022 US Senate run backed a plan entitled "Medicare Advantage for All"—could try to swiftly ram the change through without public input.
"With Mehmet Oz running the agency, they can move incredibly quickly to make that happen, and they are," Alex Lawson, executive director of the progressive advocacy group Social Security Works, told Common Dreams on Friday. "They will not explain it to the people, because the people hate the idea. Instead, they say 'change the default option' and other policy jargon to try and hide the fact of what they are doing, privatizing Medicare."
"They want to remove the guarantee of Medicare," warned Lawson, "and replace it with the same private insurance giants that make billions denying healthcare, especially to those who need it the most."
Experts say making Medicare Advantage plans the default enrollment option for seniors would likely decrease traditional Medicare enrollment dramatically.
Given massive overpayments to Medicare Advantage plans—potentially $1.2 trillion over the next decade, according to one independent estimate—a large increase in MA enrollment would be sure to drive up costs and monthly premiums across the board. A report released last month by the congressional Joint Economic Committee estimated that MA overpayments led to premium hikes of $212 per Medicare Part B enrollee last year.
"Since 2016, MA overpayments have added an estimated $82 billion to Part B premiums," the congressional report found. "[Traditional Medicare] beneficiaries, who are not enrolled in MA, bore roughly $6 billion of that burden."
Under one scheme floated last year by Rep. David Schweikert (R-Ariz.), eligible Medicare recipients would be automatically enrolled in the "MA plan with the lowest premium available," unless they actively decide to opt out. Once enrolled in an MA plan, individuals would be unable to switch plans for three years.
Wendell Potter, a former health insurance executive who now champions Medicare for All, warned Friday that under Schweikert's plan, "seniors would be locked in a plan that the government chose for them, that has a limited network of doctors and hospitals, that makes them pay the entire bill for services they might receive outside of that network, and that denies coverage for medically necessary care far more than traditional Medicare—for three years."
In addition to weighing the default enrollment change, the Trump administration has recently delivered smaller-scale but significant victories to MA insurers, including by boosting federal payment rates—bowing to a massive industry lobbying blitz—and easing rules around the marketing of MA plans.
David Lipschutz, co-director of law and policy at the Center for Medicare Advocacy, said Thursday that the latter move represents "a rollback of consumer protections, which gives in to pressures from the insurance industry and those who sell their products."
Keep ReadingShow Less
Obamacare Won’t Work: Time for Medicare for All
Our healthcare ‘system’—with or without the Affordable Care Act—is unsustainable: we have reached the end of the line.
Mar 14, 2026
Those without employer sponsored insurance (or Federal insurance like Medicare or the VA) in Red states, who signed up for the Affordable Care Act (aka Obamacare), are now learning what they voted for: higher premiums for health insurance, maybe unaffordable. Meanwhile, premiums continue to rise relentlessly for employers and employees.
Our healthcare "system" is unsustainable: we have reached the end of the line.
Americans pay more for healthcare (about18 percent of GDP) than any other developed country, with mediocre outcomes. Yet the other countries, with better outcomes, have universal coverage.
It is time for change. Extend traditional Medicare to all Americans (gradually, over the course of several years). Medicare is familiar; it works. Private for profit-health insurance, less than a century old, makes no sense today.
Sick and injured patients have turned to medicine—to healers—since time immemorial. Health insurance is new: Blue Cross started as a community non profit organization in 1929, to cover surgery in hospitals.
Private for profit-health insurance, less than a century old, makes no sense today.
Yes, we are a capitalist country, and markets are efficient at producing many things, like commodities: groceries, shoes, cars, even some insurance, when it is straightforward and highly regulated, like auto insurance. But for-profit health insurance does not work.
The idea of insurance is to spread risk over a maximum number of subscribers, each of whom is at the same low risk of unpredictable casualty, like fire. This was essentially the situation of Americans a century ago—illness and injury were acute and unpredictable, patients either recovered or died. Everyone was at similar risk, only surgery was expensive.
Today is different: illness is not only predictable, it can be chronic, even life long. Moreover, today’s scientific care is expensive. The social determinants of health—income security, education, adequate food and shelter, social support (your zip code, not your genetic code)—plus public health, keep healthy people healthy.
Medical care is for the sick.
For-profit health insurers maximize premiums, minimize cost (provider fees), keep the difference, and most important, avoid the sick. Insurers exclude those with “pre-existing” conditions whenever allowed (not under the ACA), deny "authorization" where they can. They tailor "plans" with carefully engineered restrictions you don’t discover until you file a claim. They are not even providing insurance: the payments from the Federal government are risk adjusted, so the insurers are paid more for riskier patients (and they are now illegally upcoding). The providers are not. Making this happen entails huge administrative expense, which adds no value for patients or providers, only massive returns to investors. United Health Group is the third largest company in the Fortune 500.
Healthy people don’t know what plan is "right for them"; they hate the annual "choice." They only know what they can afford. (Sick people know what they need.) They do want to choose their doctor.
Traditional Medicare eliminates these problems for its beneficiaries: by law, everything medically necessary is covered. The Federal government determines fees for doctors and hospitals based on cost, as it did historically when markets didn’t work. Beneficiaries pay premiums based on income.
Fee-for-service works when we pay the right fees for the right services. Today, based on 1950’s medicine, Medicare pays too little for office visits, so-called ‘cognitive’ services (versus procedures) both primary and specialized, so there are too few providers, especially as Medicare rolls expand with retiring
Boomers. No office doctor can make a living from Medicare anymore. That is, however, easy to fix: pay providers more to care for the sickest people, who need the services only highly skilled, experienced physicians can provide. Pay surgeons less.
Best of all, Medicare is simple—ask your grandmother.
But where will the money come from?
Start by eliminating Medicare Advantage (MA) and Part D, while updating Medicare to cover prescription drugs, along with vision, hearing aids, etc. MA was supposed to save taxpayers money by providing care more efficiently. Instead, Medicare pays MA companies 20 percent more than traditional Medicare for comparable patients.
Then, require all employers (including those who currently don’t provide insurance) to pay premiums to Medicare based on payroll. Require employees to pay Medicare premiums based on wages. Just like Social Security (of which Medicare is technically a provision). The Federal government continues to pay a share.
Everyone pays, everyone gets the care they need and nobody is left out. People can choose any qualified provider. Providers remain private, and are paid enough to attract and sustain the clinicians we want and need.
We have tried every kind of private for profit health insurance there is: employer sponsored, government subsidized, market based, capitation, value-based, catastrophic, health savings accounts—it no longer works for employers, taxpayers, or the sick. This year premiums will go up, coverage will go down.
Americans’ health will suffer.
Americans need care, not coverage. We clinicians have dedicated our lives to providing it. Medicare has served millions of us well for 60 years. We cannot allow opportunistic capitalists to stand in the way for the rest.
Keep ReadingShow Less
'Medicare Advantage Is Not Medicare': Democrats Proposal Would Unmask For-Profit Fraudsters
"We don't allow banks to call themselves the U.S. Treasury Investment Fund," said Rep. Mark Pocan. "We don't allow anyone to call themselves USPS Plus. So why allow insurance companies to call private insurance Medicare Advantage?"
Mar 05, 2026
A group of Democratic lawmakers on Wednesday reintroduced legislation aimed at reining in for-profit insurance companies who use the Medicare name to market their plans.
The "Save Medicare Act," being reintroduced by US Reps. Mark Pocan (D-Wis.), Ro Khanna (D-Calif.), and Jan Schakowsky (D-Ill.), bars private insurers from using the word "Medicare" in marketing their plans, imposing "significant fines" for any insurer that doesn't comply.
At issue, the lawmakers said, is that insurers are flooding the airwaves with ads for Medicare Advantage plans during open enrollment periods. The ads are deceiving Americans into thinking their plans are just variations of Medicare services offered by the federal government, they said.
"Let’s be clear: Medicare Advantage is not Medicare," said Schakowsky. "These private insurance plans use Medicare’s trusted name while too often denying medically necessary care, restricting providers, and overcharging taxpayers by billions. That is unacceptable. We have seen insurers exploit the system to boost profits at the expense of seniors."
Khanna noted that Medicare Advantage is "a private insurance program that too often boosts profits by limiting coverage," even as it "misleads seniors into thinking it's traditional Medicare."
"That's wrong," Khanna emphasized. "This legislation will stop private insurers from cashing in on the Medicare name. We should be working to protect and expand real Medicare instead."
Pocan declared that "only Medicare is Medicare," adding that Medicare Advantage plans "often leave patients without the benefits they need while overcharging the federal government for corporate profit."
"This bill makes clear what is—and what is not—Medicare," added Pocan, "and ensures this essential program will continue to serve seniors and other Americans for generations to come."
Pocan also posted a video on social media where he talked about his elderly mother being unable to see the physician that came to her assisted living home because she relied on Medicare Advantage and the doctor in question was out of network.
"She would have had to go all the way across town to get that care," Pocan explained. "The problem is, she wasn't very mobile and she never got the medical care."
We don't allow banks to call themselves the U.S. Treasury Investment Fund. We don't allow anyone to call themselves USPS Plus.
So why allow insurance companies to call private insurance Medicare Advantage?
I’m reintroducing the Save Medicare Act with @RepRoKhanna and… pic.twitter.com/c6dAXpEJqY
— Rep. Mark Pocan (@RepMarkPocan) March 4, 2026
"We don't allow banks to call themselves the U.S. Treasury Investment Fund," said Pocan. "We don't allow anyone to call themselves USPS Plus. So why allow insurance companies to call private insurance Medicare Advantage?"
Many progressive critics have for years pointed to Medicare Advantage as a legitimate example of wasteful spending by the federal government.
A report released in January by the Medicare Payment Advisory Commission (MedPAC), an independent congressional agency that advises lawmakers on Medicare, estimated that overpayments to Medicare Advantage plans could total $76 billion in 2026.
One major factor in the overpayments is that patients using Medicare Advantage plans tend to be healthier than patients on traditional Medicare, with the result being that private insurers charge the government more than is necessary to meet these patients' needs.
On Wednesday, Schakowsky said that the "crucial legislation" she joined Khanna and Pocan in introducing "will end deceptive marketing and ensure beneficiaries understand the difference between traditional Medicare and private insurance plans."
"Seniors deserve transparency, accountability, and the full benefits they have earned," she said.
Keep ReadingShow Less
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."
Keep ReadingShow Less
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.
Keep ReadingShow Less
Medicare Advantage, Privatized Medicaid Could Cost Americans $2 Trillion Extra Over Next Decade
"If the administration were serious about curbing waste and inefficiency, it would start by reducing the diversion of public funds to these corporate intermediaries," argues a new paper.
Nov 07, 2025
US President Donald Trump and his Republican allies in Congress took a sledgehammer to Medicaid over the summer, justifying the unprecedented cuts by falsely claiming the program that provides health coverage to tens of millions of low-income Americans is overrun with waste and abuse.
But a new paper published Friday in the journal Health Affairs argues that if the administration actually wanted to target waste, fraud, and abuse, it would have been much better off taking aim at Medicare Advantage (MA) and Medicaid privatization.
The paper's authors estimate that overpayments to MA plans—which are funded by the government and run by for-profit insurers—and private Medicaid managed care will likely cost US taxpayers a total of $1.92 trillion over the next 10 years.
"Ending that waste would inflict losses on private insurers' shareholders and executives (the CEO of the largest MA firm made $26.3 million last year). But patients, not just government coffers, might gain," wrote Adam Gaffney, Danny McCormick, Steffie Woolhandler, and David Himmelstein.
"Even Congress' trillion-dollar cuts to Medicaid and food assistance amount to little more than half of the potential savings from de-privatizing Medicaid and Medicare," they added. "Reclaiming those funds would require reversing the decades-long trend of outsourcing to profit-seeking intermediaries and restoring Medicare and Medicaid as efficiently administered public programs."
Far from aggressively taking on Medicare Advantage fraud, the Trump administration handed MA plans a major gift earlier this year by approving an average federal payment increase of roughly 5.1%—more than double the 2.2% increase proposed by the Biden administration in January.
The authors of the new paper noted that the huge raise for MA plans, which are notorious for denying necessary care in pursuit of ever-larger profits, will add $25 billion in waste to the US healthcare system next year alone.
"If the administration were serious about curbing waste and inefficiency," they wrote, "it would start by reducing the diversion of public funds to these corporate intermediaries."
Keep ReadingShow Less
Just Say No to AI-Assisted Medicare Preauthorization
A new AI-driven Medicare prior-authorization pilot could dramatically weaken Medicare, just another frightening step toward privatization and profiteering.
Sep 03, 2025
The odds are that if you have private health insurance or someone in your family has private health insurance, you have heard the dreaded phrase “we need preauthorization” from your insurance company. What this means is that your insurance company needs to approve in advance that your treatment or prescription is covered. In theory, this should be no big deal. However, reality is something else. But as the New York Times points out:
Private insurers often require a cumbersome review process that frequently results in the denial or delay of essential treatments that are readily covered by traditional Medicare. This practice, known as prior authorization, has drawn public scrutiny, which intensified after the murder of a UnitedHealthcare executive last December.
So, reading this you might think that you are glad that you or someone in your family choose traditional Medicare (in other words not a Medicare Advantage plan), so you would be able to avoid the “prior authorization needed” drama. Well, unfortunately you would be wrong as the prior authorization is slowly coming to Medicare. In late June, the Centers for Medicare and Medicaid Services (CMS) issued a press release:
The Centers for Medicare & Medicaid Services (CMS) is announcing a new Innovation Center model aimed at helping ensure people with Original Medicare receive safe, effective, and necessary care. Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars. This model builds on other changes being made to prior authorization as announced by the US Department of Health and Human Services and CMS on Monday.
In theory, this move by CMS does not sound bad. Who could be against reducing wasteful spending in Medicare and making sure that people receive appropriate treatment? A spokesman for CMS has been quoted that the government would not review emergency services or hospital stays.
The CMS prior Medicare authorization model is being rolled out in January 2026 as a six-year trial program in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington State. In theory, the preauthorization program will look at those medical treatments that are not of benefit to Medicare beneficiaries.
What CMS is not drawing attention to is that this preauthorization will be done by artificial intelligence (AI)—or as CMS puts it “enhanced technologies.” It is not until much later in the press release that CMS gets to the fact that AI will do the screening authorization:
The WISeR Model will test a new process on whether enhanced technologies, including artificial intelligence (AI), can expedite the prior authorization processes for select items and services that have been identified as particularly vulnerable to fraud, waste, and abuse, or inappropriate use.
CMS, at the moment, says that the AI preauthorization screening will be used on only an extremely limited number of procedures. But what guarantees do Medicare beneficiaries have? The bottom line is that you have to ask yourself: Would you be comfortable having your access to your earned Medicare benefits be determined by AI? My answer is a firm, “No, thank you.”
We also need to ask what are the financial incentives that Medicare is injecting into the system though preauthorization? It is hard not to conclude that this is a step toward privatization of traditional Medicare.
Healthcare professionals are concerned by CMS’ preauthorization program. In mid-July, the American Medical Association (AMA) wrote to CMS:
While the stated goal of the model is to curb wasteful spending and protect the Medicare Trust Fund, the mechanisms employed raise several significant issues that must be addressed prior to implementation. The AMA strongly urges CMS to pause the January 1, 2026 implementation of the WISeR Model to allow additional stakeholder input, full analysis of the model’s operational impacts, and development of clear guidance for physicians. Physicians should not be forced to adapt to such substantial administrative requirements without sufficient time to understand the implications and prepare. Absent this opportunity for meaningful physician and stakeholder engagement, the model risks creating confusion, administrative burden, and unintended consequences that could ultimately undermine CMS’ own goals to reduce waste, fraud, and abuse.
On Capitol Hill, a number of House Democrats led by Rep. Alexandria Ocasio-Cortez of New York have pushed back on the AI preauthorization pilot project. In late July, they wrote to CMS:
We understand that CMMI has intentionally selected healthcare services that are reported to have limited clinical value and may be vulnerable to abuse in the Medicare program, and we support efforts to ensure Medicare remains a good steward of taxpayer dollars. However, the expansion of AI-fuelled prior authorization will not improve program integrity in Traditional Medicare. Giving private for-profit actors a veto over care provided to seniors and people with disabilities in Traditional Medicare, even as a pilot program, opens the door to further erosion of our Medicare system. We therefore strongly urge you to immediately halt the proposed WISeR model and instead consider steps to address the well-documented waste, fraud, and abuse in the Medicare Advantage program.
The House Democrats raise a very intriguing question about why CMS is not focused more on fighting waste, fraud, and abuse in Medicare Advantage plans? As the Center for Budget and Policy Priorities reported in January of this year, there is considerable evidence to show that Medicare Advantage plans are overpaid by the government. It would make sense for CMS in pursing fraud and waste to follow the money which means looking at Medicare Advantage plans.
Give the political dynamics in Washington, it seems likely that the CMS preauthorization demonstration project will go into effect in January 2026. Then in the summer of 2026, with the midterm elections looming, as members of Congress will begin hearing from constituents who have had their earned Medicare benefits denied by AI, Congress will revisit this issue. It is tragic that in the meantime people will be hurt.
Keep ReadingShow Less
Senate Dems Probe UnitedHealth Scheme to Slash Patient Care Costs at Nursing Homes
One whistleblower accused the giant corporation of "compelling medical professionals to comply with its financially-driven playbook at the expense of patient safety."
Aug 07, 2025
A pair of Democratic senators on Thursday launched an investigation into the most powerful corporation in the U.S. healthcare system, sounding alarm over allegations that UnitedHealth Group is incentivizing nursing homes to slash care expenses for patients insured by the company.
Sens. Ron Wyden (D-Ore.) and Elizabeth Warren (D-Mass.) wrote in a new letter to the company's CEO that UnitedHealth Group (UHG) has "been at the center of numerous reports suggesting that it is maximizing profits at the expense of patients' health and well-being," including accusations that the company "systematically denied needed care to children and adults with chronic illnesses" and used an artificial intelligence algorithm to deny Medicare Advantage enrollees necessary care.
Most recently, the senators noted, reporting by The Guardian alleged that UnitedHealth is using a bonus scheme to push nursing homes that contract with Optum to reduce hospital transfers as part of an aggressive cost-cutting effort. Optum is a UHG subsidiary that employs or affiliates with roughly 10% of all physicians in the U.S.
Wyden and Warren demanded that UnitedHealth provide answers to numerous questions related to its practices at nursing homes, including whether it institutes "hospital transfer quotas" at the facilities it works with.
"UHG denies the allegations in The Guardian's reporting and maintains that its practices reflect best practices in the care of nursing home residents," the senators wrote. "However, we are concerned that the methods UHG appears to rely on to deliver the high-quality care it purports to provide may in fact incentivize practices that threaten resident safety."
"I'd like to see them held accountable for putting profits over patients."
The Guardian's reporting underscores the extent to which UHG has injected itself into virtually every aspect of the American healthcare system. The healthcare conglomerate has roughly 2,700 subsidiaries, according to an analysis by the Center for Health and Democracy.
Using confidential corporate and patient records, whistleblower accounts, and interviews with UHG staffers and nursing home employees, The Guardian examined a company program under which Optum medical teams provide care on-site at nursing homes or in partnership with facility staff.
The newspaper identified "several cases" in which "nursing home residents who needed immediate hospital care under the program failed to receive it, after interventions from UnitedHealth staffers."
"At least one lived with permanent brain damage following his delayed transfer, according to a confidential nursing home incident log, recordings, and photo evidence," the newspaper reported. "To reduce residents' hospital visits, UnitedHealth has offered nursing homes an array of financial sweeteners that sounded more like they came from stockbrokers than medical professionals."
The company also allegedly gave its medical teams "budgets" limiting the number of hospital admissions they could allow for nursing home patients.
One whistleblower, a nurse practitioner formerly employed by a UnitedHealth insurance subsidiary, said in a statement that "scores of elderly patients may never have received the care that they needed, all because UnitedHealthcare skimped on care to cut costs."
“UnitedHealthcare is compelling medical professionals to comply with its financially-driven playbook at the expense of patient safety in a way that pressures providers to violate their ethical obligations," the whistleblower added. "I'd like to see them held accountable for putting profits over patients."
UnitedHealth raked in over $34 billion in profits last year—far more than any other U.S. healthcare company.
Wendell Potter, a former Cigna executive who now serves as president of the Center for Health and Democracy, wrote in a recent blog post that mounting scrutiny of UHG's practices shows the company is "facing a reckoning it can't ignore."
"It's coming from every direction: the U.S. Department of Justice (under President Donald J. Trump), congressional Republicans and Democrats, state lawmakers and regulators, the media, physicians, hospital administrators, tens of thousands of Americans on the internet sharing their own personal UnitedHealth horror stories, and, most importantly for the C-Suite, enraged investors who've lost hundreds of billions of dollars in recent months," Potter wrote.
Keep ReadingShow Less
Why We Can't Simply Celebrate Medicare's 60th Birthday
Let's not allow President Trump and congressional Republicans to shred one of the greatest legacies of LBJ's Great Society.
Jul 30, 2025
Medicare turns 60 years old today. Former U.S. President Lyndon B. Johnson signed it into law on July 30, 1965, giving seniors a guarantee of health coverage that never existed before. Prior to Medicare's enactment, it was nearly impossible for older people to obtain health insurance, as they were considered a "bad risk."
Medicare provides universal coverage to Americans over 65 years of age. The law created Medicare Part A as a national hospital insurance program. Part B is a voluntary program for doctor visits and other medical services. Medicare Part C is another name for the privatized, for-profit version of the program called "Medicare Advantage." And Part D is the prescription drug program enacted in 2003.
The Hospital Insurance portion is funded through workers' payroll contributions. At the signing ceremony in Independence, Missouri, LBJ said, "Through this new law, every citizen will be able, in their productive years when they are earning, to insure themselves against the ravages of illness in his old age."
Lyndon Johnson paid tribute to former President Harry S. Truman, presenting him with the very first Medicare card. It was Truman who, 20 years earlier, had proposed a form of universal medical coverage for the American people.
LBJ quoted Truman's remarks from the 1940s:
Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.
It turned out that the time had not yet arrived. Truman's proposal failed to gain traction during a time of retrenchment from the expansions of the New Deal, and a Republican majority on Capitol Hill which he famously labeled the "Do-Nothing Congress."
President Johnson's determination to enact his Great Society agenda (of which Medicare was a large part) and sheer political muscle—not to mention solid Democratic control of Congress—pushed Medicare (and its sister program, Medicaid) into being.
Naturally, Medicare faced strong opposition from conservatives. None other than Ronald Reagan made the ludicrous prediction that if Medicare were enacted, "You and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free." Sixty years later, we are no less "free" because of Medicare. In fact, having guaranteed healthcare makes seniors and people with disabilities (and their families) much more free—from disease, from worry, and financial ruin.
Today, 68 million people rely on Medicare for health coverage, including 12 million who are dually eligible for Medicare and Medicaid. Medicare isn't perfect: The for-profit Medicare Advantage (Part C) program is extremely problematic (see below). The Medicare Part A trust fund will become depleted in 2033 if Congress fails to take action to strengthen it. Traditional Medicare still doesn't cover basic hearing, vision, and dental care—which we have been pushing for many years. But most concerning of all—President Donald Trump and his party have spent this 60th anniversary year actively undermining both Medicare and Medicaid.
The "Unfair, Ugly" bill that Trump signed earlier this month slashed nearly $1 trillion from Medicaid, which will strip health coverage from an estimated 10 to 16 million lower-income Americans. The new law—projected to add some $4 trillion to the national debt—could trigger cuts to Medicare down the road.
Meanwhile, the Trump administration is recklessly taking steps to privatize the entire Medicare program. It has announced a pilot project to involve private companies in conducting prior authorizations for care in traditional Medicare. The administration, under Health and Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare and Medicaid Services Director Mehmet Oz, also has announced a plan to automatically enroll new Medicare beneficiaries in the for-profit Medicare Advantage (MA) program—a huge gift to the multibillion dollar insurance industry at the expense of patients.
The problems with Medicare Advantage (MA) have become legendary. Enrollees are basically put into health maintenance organizations run by insurance giants, with limited networks of providers. Unreasonable denials of care are rampant. Patients who become disenchanted with MA plans often find it nearly impossible to switch to traditional Medicare. Meanwhile, some MA Insurers have been overcharging the government for their services and ripping off taxpayers. (Several of these companies are currently under investigation.)
We are watching to see if the Trump administration, which talks a good game about lowering prescription medication costs while simultaneously doing favors for Big Pharma, will honor the provisions of President Joe Biden's Inflation Reduction Act, which made myriad patient-friendly reforms to the Part D drug program—including out of pocket caps for beneficiaries and empowering Medicare to negotiate prices with the industry.
The bottom line is: Let's not allow President Trump and congressional Republicans to shred one of the greatest legacies of LBJ's Great Society. We and our fellow advocacy groups are pushing back—and so is the grassroots "Hands Off" movement. But we don't want to be fighting this same battle every time Medicare (and Medicaid) mark an anniversary when we should be purely celebrating.
Keep ReadingShow Less
See More
Most Popular
To inform. To inspire. To ignite change for the common good.
News & Opinion
Trending
Common Dreams, Inc. Founded 1997. Registered 501(c3) Non-Profit
Privacy Policy