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medicare privatization
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."
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Sanders Gets GOP Leader to Agree to Work On Medicare Covering Dental, Hearing, and Vision
The exchange on the Senate floor came after the Finance Committee chair blocked passage of the Vermont Independent's bill.
Mar 11, 2025
U.S. Senate Finance Committee Chair Mike Crapo on Tuesday blocked passage of Sen. Bernie Sanders' legislation to expand Medicare to cover dental, hearing, and vision care for tens of millions of American seniors, but the bill's sponsor got the panel leader to publicly agree to further discuss the issue.
Sanders (I-Vt.) took to the Senate floor Tuesday afternoon to ask for unanimous consent to pass the Medicare Dental, Hearing, and Vision Expansion Act, which is spearheaded in the House of Representatives by Congressman Lloyd Doggett (D-Texas).
"In the richest country in the history of the world, it is unacceptable that millions of seniors are unable to read because they can't afford eyeglasses, can't have conversations with their grandchildren because they can't afford hearing aids, and have trouble eating because they can't afford dentures," Sanders said in a statement.
"That should not be happening in the United States of America in the year 2025," he continued. "The time is long overdue for Congress to expand Medicare to include comprehensive coverage for the dental, vision, and hearing care that our seniors desperately need."
After Crapo (R-Idaho) rose to stop the bill from advancing, he and Sanders had a brief exchange in which the Republican agreed to working on achieving the "outcome" of the federal healthcare program covering dental, vision, and hearing.
In Sanders' remarks on the Senate floor about his bill, he sounded the alarm about efforts by President Donald Trump, billionaire Elon Musk, and congressional Republicans to cut government healthcare programs and Social Security.
"Yeah, we have more nuclear weapons than any other country, we have more billionaires than any other country, but we also have one of the highest rates of senior poverty of any country on Earth. We might want to get our priorities right," said Sanders, who has long fought for achieving universal healthcare in the United States via his Medicare for All legislation.
"While my Republican colleagues would like to make massive cuts to Medicaid in order to provide more tax breaks to billionaires, some of us have a better idea," he said. "We think that it makes more sense to substantially improve the lives of our nation's seniors by expanding Medicare to cover dental, vision, and hearing benefits."
To pay for his expansion plan, Sanders calls for ensuring that Medicare pays no more for prescription drugs than the Department of Veterans Affairs and addressing the tens of billions of dollars that privately administered Medicare Advantage plans overcharge the federal government annually.
In a statement about the bill, Doggett highlighted that "this expanded care could help prevent cognitive impairment and dementia, worsened chronic disease, and imbalance leading to falls with deadly consequences. This is an essential step to fulfilling the original promise of Medicare—to assure dignity and health for all."
Welcoming their renewed push for Medicare expansion, Public Citizen healthcare advocate Eagan Kemp declared that "at the same time Trump and his cronies in Congress try to rip healthcare away from millions and push for further privatization of Medicare, Sen. Sanders and Rep. Doggett are showing what one of our top priorities in healthcare should be—improving traditional Medicare."
"The introduction of this legislation is an important step to ensure Medicare enrollees can access the care they need, and we hope that Congress will act quickly to pass these commonsense reforms," Kemp added. "Healthcare is a human right."
Earlier Tuesday, in anticipation of Crapo's committee holding a confirmation hearing for Dr. Mehmet Oz, the former television host Trump has nominated to lead the Centers for Medicare and Medicaid, Public Citizen released a research brief about the hundreds of millions of dollars Medicare Advantage companies have spent on lobbying.
"If Oz is confirmed as the CMS administrator," Kemp warned, "attacks on traditional Medicare are likely to move into overdrive."
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Watchdog Says Dr. Oz Push for 'Medicare Advantage for All' Is Disqualifying
"Oz's deep ties to the private healthcare industry make his nomination to lead our nation's current healthcare system totally egregious," said Public Citizen healthcare advocate Eagan Kemp.
Dec 20, 2024
The watchdog group Public Citizen said Thursday that lawmakers should reject President-elect Donald Trump's nomination of Medicare privatization advocate Mehmet Oz to lead a key health agency and instead move toward a publicly run single-payer system that would cover all Americans at a lower cost than the status quo.
In a new brief, Public Citizen warned that Medicare privatization efforts—particularly via an expansion of Medicare Advantage plans run by for-profit insurance companies—would likely "move into overdrive" if the Senate confirms Oz as administrator of the Centers for Medicare and Medicaid Services (CMS).
Ahead of his 2022 Senate bid, Oz backed a plan he described as "Medicare Advantage for All," under which privately run plans would cover non-seniors and "all Americans who are not on Medicaid"—effectively eliminating traditional Medicare.
Public Citizen warned such a plan "would mean huge corporate profits while patients continue to struggle to get the healthcare they need," noting that Medicare Advantage plans are notorious for denying necessary care and overbilling the federal government to the tune of tens of billions of dollars per year.
"Policymakers should pass Medicare for All to guarantee care for everyone in the U.S., bring down costs for working families, and generate savings for the country as a whole."
"Further privatizing Medicare would increase healthcare costs systemwide by adding further administrative bloat to our healthcare system," the new brief argues. "Our healthcare system is already made up of thousands of health insurance plans offered by numerous insurers as well as state and federal programs that all play some role in paying for healthcare."
"By spending healthcare resources on corporate profit or administrative waste, privatized Medicare would mean Americans pay even more for healthcare than they already do," the brief adds. "We already spend far more than comparably wealthy countries, over $12,500 per capita, compared with peer nations that are spending around half, per capita."
Oz's plan would also benefit companies in which he has invested tens of millions of dollars, according to financial disclosures.
"Dr. Oz owned between $280,000 and $600,000 in shares in UnitedHealth Group, a major Medicare Advantage insurer, and between $50,000 and $100,000 in shares of CVS Health," Public Citizen noted Thursday, citing the filings.
Eagan Kemp, a healthcare advocate at Public Citizen, said in a statement that Oz's "Medicare Advantage for All" proposal "is dangerous to all patients, especially seniors and people with disabilities, many of whom have not received the care they need under Medicare Advantage."
"Healthcare is a right, not a commodity," said Kemp. "Oz's deep ties to the private healthcare industry make his nomination to lead our nation's current healthcare system totally egregious. Congress should reject Oz's nomination and any proposal to further privatize Medicare."
"Instead," he added, "policymakers should pass Medicare for All to guarantee care for everyone in the U.S., bring down costs for working families, and generate savings for the country as a whole."
Public Citizen's brief came as Oz's nomination faced increasingly close scrutiny from congressional Democrats, who have raised similar concerns about the former television personality's promotion of Medicare Advantage and ties to the private insurance industry.
"As CMS administrator, you would be tasked with overseeing Medicare and ensuring that the tens of millions of seniors that rely on the program receive the care they deserve, including cracking down on abuses by private insurers in Medicare Advantage," a group of Democratic lawmakers led by Sen. Elizabeth Warren (D-Mass.) wrote in a letter to Oz last week. "The consequences of failure on your part would be grave. Billions of federal healthcare dollars—and millions of lives—are at stake."
"Given your financial ties to private insurers, combined with your view that the traditional Medicare program is 'highly dysfunctional' and your advocacy for eliminating it entirely," the lawmakers added, "it is not clear that you are qualified for this critical job."
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New Biden Rule Would Rein in Medicare Advantage. Will Dr. Oz Let It Stand?
"There's every reason to expect the Trump administration to block these proposed rules from moving forward," warned Public Citizen co-president Robert Weissman.
Nov 27, 2024
The Biden administration on Tuesday unveiled a new rule aimed at reining in privatized Medicare Advantage plans, which have drawn growing federal scrutiny for denying coverage claims en masse—sometimes using artificial intelligence—and overbilling the government to the tune of tens of billions of dollars per year.
But the proposal could soon be fed through the buzzsaw of the incoming Trump administration, which is likely to have an outspoken Medicare Advantage supporter, Mehmet Oz, at the helm of the Centers for Medicare and Medicaid Services (CMS).
Biden's CMS said in a fact sheet released Tuesday that the new rule would ensure MA companies make enrollees aware of their right to appeal coverage denials. CMS pointed to data showing that MA plans, which now cover more than half of the Medicare-eligible population, "overturn 80% of their decisions to deny claims when those claims are appealed."
"These data also show that a low percentage of denied claims are appealed, meaning many more could potentially be overturned by the plan if they were appealed," CMS added.
The rule would also look to constrain MA plans' deceptive marketing practices and "use of inappropriate prior authorization." Prior authorization is a byzantine process under which providers must demonstrate that a proposed treatment is medically necessary before the insurer will cover it.
"The big question, of course, is what will the Trump administration do with these rules? Will they side with patients needing treatment or care-denying big insurers?"
Robert Weissman, co-president of the consumer advocacy group Public Citizen, welcomed the new rule as a "common-sense" measure that would "limit" some of the damage inflicted by MA plans, which are notorious for denying patients necessary care.
"The big question, of course, is what will the Trump administration do with these rules? Will they side with patients needing treatment or care-denying big insurers?" Weissman continued. "Unfortunately, despite its populist pretensions, there's every reason to expect the Trump administration to block these proposed rules from moving forward. Dr. Mehmet Oz, Trump's nominee to run the Centers for Medicare and Medicaid Services, is a major proponent of expanding privatized Medicare, with nary a worry about privatized Medicare's rampant abuses and rip-offs of taxpayers."
Sen. Ron Wyden (D-Ore.), chair of the Senate Finance Committee, vowed Tuesday that he will "be watchdogging the incoming Trump administration to ensure there is no backsliding on these critical consumer protections and coverage improvements."
Oz, a long-time television personality known for hawking unproven treatments, has been characterized as a "shill" for MA, a program funded by taxpayers and run by for-profit insurance companies.
As recently as August, Oz boosted Medicare Advantage on his YouTube account, as New York magazine reported earlier this week:
In August, Dr. Mehmet Oz's official YouTube account posted a video titled "Get $0/Month Medicare Coverage: What You Need to Know," in which Oz lays a sales pitch on his viewers. "Which of these items can you get for zero dollars?" he says, pointing to images of a coffee cup, a pack of gum, and a newspaper, as if quizzing a toddler on the pictures in a children’s book. "Or how about a health insurance plan?" he says. If you've ever watched daytime television, you know how the next part goes: Oz reveals he was, indeed, talking about the health insurance plan, and the studio audience erupts into applause. He then brings out an insurance agent to paint a rosy portrait of Medicare Advantage before ending with a call to action, encouraging any seniors in the audience to call in to a special phone number or visit a website to learn more and enroll.
During his 2022 bid for a U.S. Senate seat, Oz campaigned on a proposal he called "Medicare Advantage for All"—while owning stock in UnitedHealth Group, the nation's largest MA insurer.
Oz's support for Medicare Advantage aligns with the Project 2025 agenda, which calls for making MA the default enrollment option for U.S. seniors—an existential threat to traditional Medicare. Such a sweeping change would hugely benefit UnitedHealth and other private insurance giants.
"Project 2025's plans for Medicare, seconded by Dr. Oz, will end Medicare as we know it, and leave seniors to the tender mercies of dishonest and debased private insurance plans," The American Prospect's Robert Kuttner warned Tuesday. "What's insidious is that none of these changes require legislation. The best we can hope for is that the sunlight of exposure of these schemes will act as a disinfectant."
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IG Report Highlights Medicare Advantage Rip-Offs Trump Would Make Even Worse
The new report was released as allies of Republican nominee Donald Trump push to make privatized Medicare Advantage plans the default enrollment option for U.S. seniors.
Oct 24, 2024
An inspector general report published Thursday estimates that the U.S. federal government delivered around $7.5 billion in potentially improper payments to for-profit Medicare Advantage companies last year, a finding that came as allies of Republican nominee Donald Trump are pushing to make privatized MA plans the default enrollment option for the nation's seniors.
The new report from the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services focuses specifically on health risk assessments (HRAs) and chart reviews, mechanisms that MA companies use to gauge enrollees' health and help determine the size of payments the insurers receive from the federal government.
The OIG report characterizes MA companies' use of HRAs and chart reviews as "questionable," noting that the program's insurers have a history of making patients appear sicker than they are to receive larger payments from Medicare.
"Diagnoses reported only on enrollees' HRAs and HRA-linked chart reviews, and not on any other 2022 service records, resulted in an estimated $7.5 billion in MA risk-adjusted payments for 2023," the report states. "The lack of any other follow-up visits, procedures, tests, or supplies for these diagnoses in the MA encounter data for 1.7 million MA enrollees raises concerns that either: (1) the diagnoses are inaccurate and thus the payments are improper or (2) enrollees did not receive needed care for serious conditions reported only on HRAs or HRA-linked chart reviews."
The report raises particular concern about the validity of HRAs and chart reviews conducted at patients' homes "because these tools are often administered by MA companies or their third-party vendors and not enrollees' own providers."
Last year, according to the OIG report, "in-home HRAs and HRA-linked chart reviews generated 63% of the estimated $7.5 billion in risk-adjusted payments."
"Any inaccurate diagnoses from these in-home HRAs and associated chart reviews may have resulted in overpayments to the MA companies," the report states. "For diagnoses that were accurate, enrollees may have gone without needed care."
Diane Archer, senior adviser on Medicare at the progressive advocacy group Social Security Works, told Common Dreams that "we need to stop paying MA insurers more for their sickest patients when they don't provide them with needed care."
"We need to penalize them in meaningful ways for ripping off taxpayers and harming their patients," said Archer. "We need to stop assuming that the insurers are managing people's care. They are overcharging the government and denying needed care, sometimes indiscriminately, to boost their profits."
"If Trump's plan takes effect, the number of Medicare Advantage policies UnitedHealth controls is expected to reach 15.6 million."
Medicare Advantage, a privately run program funded by the federal government, has faced growing scrutiny in recent years as enrollment in the program has surged. More than half of the Medicare-eligible population in the U.S. is enrolled in a Medicare Advantage plan, according to KFF, resulting in massive profits for insurance giants.
The new OIG report found that just 20 MA insurers—including UnitedHealth, Cigna, and Humana—accounted for 80% of the $7.5 billion in government payments stemming from HRAs and chart reviews last year.
"One top MA company, UnitedHealth Group, Inc., stood out from its peers, especially in its use of in-home HRAs and HRA-linked chart reviews to generate risk-adjusted payments," the report says.
UnitedHealth is one of the insurance behemoths that stands to benefit most from a plan crafted by Trump allies that would funnel more seniors into MA plans, which are notorious for denying necessary care and overcharging Medicare to the tune of tens of billions of dollars per year.
People's Action estimated in a report published last week that UnitedHealth could see its revenue from Medicare Advantage double to $274 billion annually if Trump wins next month's election and enacts Project 2025's proposal to make the privatized plans the default enrollment option for new Medicare beneficiaries.
Democratic nominee Kamala Harris, for her part, has called for an expansion of traditional Medicare to cover home health services as well as hearing and vision—benefits that are key selling points of MA plans.
Sulma Arias, executive director of People's Action, warned in an op-ed for Common Dreams on Thursday that Trump's "only plan for healthcare in a second term is to privatize."
"If Trump's plan takes effect, the number of Medicare Advantage policies UnitedHealth controls is expected to reach 15.6 million," Arias wrote. "One out of every three Medicare Advantage policyholders is denied care by private insurers like United every year. Under Trump's plan, UnitedHealth alone would deny care to as many as 5.2 million people."
"This ability to deny care," Arias added, "is what makes Medicare Advantage plans far more profitable to private insurers than any other plans they offer."
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In Undercover Video, Project 2025 Architect Says Trump Is 'Very Supportive of What We Do'
A watchdog group secretly recorded Russell Vought, a former Trump administration official, explaining his plan to get confidential Project 2025 plans into the Republican nominee's hands if he wins in November.
Aug 15, 2024
A key architect of Project 2025 believed he was speaking to relatives of a wealthy right-wing donor when he described his plan to share a flurry of secret executive orders, proposed regulations, and other documents directly with Republican presidential nominee Donald Trump and his transition team if he wins another White House term in November.
In fact, Russell Vought—who served as director of the Office of Management and Budget during Trump's first term—unwittingly divulged his strategy to an undercover journalist and a paid actor working undercover for the Centre for Climate Reporting (CCR), an investigative organization based in the United Kingdom.
During the nearly two-hour conversation, which was secretly recorded by CCR's undercover team, Vought boasted of his close proximity to Trump and voiced confidence that he will be able to get Project 2025's confidential 180-day plan into the Republican nominee's hands following the November election, despite the former president's false claim that he knows "nothing about" the project.
"There are people like me that have his trust that will be able to get it to him in whatever position we're at," said Vought, who is expected to receive a high-ranking post in a potential second Trump administration. "The relationships will be there. The trust level will be there."
Vought, founder of the Center for Renewing America (CRA), went on to describe Project 2025's secret plan as a "very, very close hold," which CCR noted is a phrase used by the U.S. government for documents that aren't for public consumption.
Watch CCR's video of its conversation with Vought, who expressed his desire to "rehabilitate Christian nationalism," pursue "the largest deportation in history," and "block funding for Planned Parenthood":
NEW
We went undercover in Project 2025.
Our investigation uncovered details of the secretive second phase of Project 2025 being led by a Trump insider, with plans to feed hundreds of highly-confidential battle plans directly into the Trump transition team.
Watch here. pic.twitter.com/je9qHpjAns
— Centre for Climate Reporting (@ClimateReport_) August 15, 2024
Much of the media attention on Project 2025—a sweeping far-right agenda crafted by more than 100 conservative groups and many former Trump administration officials—has centered on the initiative's 922-page "Mandate for Leadership," a document that outlines plans to abolish the Education Department, further privatize Medicare, roll back climate regulations and abortion protections, and centralize power in the executive branch.
Such plans are deeply unpopular with the U.S. public, according to recent polling.
But in recent weeks, Democratic lawmakers and watchdogs have attempted to shine light on what Project 2025 has called the "Fourth Pillar" of its agenda, which is briefly described on the project's website as a "180-day transition playbook" that contains "a comprehensive, concrete transition plan for each federal agency."
Micah Meadowcroft, who worked in the Environmental Protection Agency during Trump's first term, told CCR's undercover reporter that Vought has "supervised" the handling of Project 2025's secretive "second phase," which aims to "break down actual policy packets and executive orders and agenda items and things like that."
"He's the team lead behind the scenes, just putting all that together," said Meadowcroft, who helped set up the meeting between Vought and CCR's undercover team. "I have colleagues who officially work for CRA, but like 35 out of their 40-hour work week is Project 2025 stuff."
Meadowcroft went on to describe Project 2025's secret plan as "a big, fat stack of papers that will be distributed during the transition period, but not as part of the transition."
"Because obviously, you want as little of it to be FOIA-able... as possible," he added, referring to the ability of members of the press and the public to request documents under the Freedom of Information Act.
Vought told CCR that he is "overseeing a large team that is developing 350 different transition documents, consisting of draft executive orders, secretarial memos, and regulations," the outlet noted in its detailed story on the investigation.
"His priority, he said, is to provide detailed plans for enacting policies he already knows Trump wants to carry out, based on the former president's campaign speeches," CCR continued. "He is confident that these plans won't end up in a White House shredder, despite the Trump campaign's insistence that they have nothing to do with Project 2025. He suggested that Trump's disavowal of Project 2025 is a pre-election political ploy rather than anything substantive."
As Vought himself put it: "He's running against the brand. He is not running against any people; he is not running against any institutions."
"He's very supportive of what we do," Vought said of Trump's stance on the Center for Renewing America, which CCR noted is "responsible for promulgating some of the most radical Project 2025 policy ideas."
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'Hell No': Trump Allies' Plan to Privatize Medicare Draws Alarm and Outrage
A right-wing coalition's proposal to make Medicare Advantage the default enrollment option would be a "clear handout to the private insurance industry," said one critic.
Feb 06, 2024
A right-wing coalition that's been laying the policy groundwork for another Trump presidency has developed a plan to further privatize Medicare by making fraud-riddled Medicare Advantage "the default enrollment option" for newly eligible beneficiaries.
The plan, highlighted Monday by Rolling Stone's Andrew Perez, is outlined about halfway through Project 2025's 920-page playbook for the first six months of a conservative presidency.
Republican administrations and right-wing groups have long advocated funneling people who are newly eligible for Medicare into Medicare Advantage plans, which are funded by the federal government and run by for-profit insurers. During his first White House term, former President Donald Trump took steps to actively encourage seniors to choose Medicare Advantage plans over traditional Medicare and expanded the benefits that the privately run plans are allowed to offer.
Those efforts have had an impact. As Perez noted, "Last year, for the first time ever, a majority of Americans eligible for Medicare were on privatized Medicare Advantage plans."
"If Republicans win the presidential race this year," he wrote, "the push to fully privatize Medicare, the government health insurance program for seniors and people with disabilities, will only intensify."
Every year, new and existing Medicare recipients have an opportunity to enroll in Medicare Advantage plans, which engage in aggressive and often highly deceptive advertising practices to lure seniors who are often seeking out benefits not currently offered by traditional Medicare, such as vision and dental care.
"Donald Trump and his MAGA Republican cronies plan to totally privatize Medicare if they win in November's election."
Once enrolled in Medicare Advantage plans—which offer limited networks of doctors and overbill the government to the tune of $140 billion a year—patients often feel trapped and are subjected to care denials and other deep flaws in the program that have drawn growing attention from lawmakers in recent years.
If Project 2025, which is led by the right-wing Heritage Foundation, gets its way, Medicare Advantage providers would be given even greater power over the critical government insurance program. The Trump administration embraced many of the Heritage Foundation's policy recommendations during its first year in power.
"Donald Trump and his MAGA Republican cronies plan to totally privatize Medicare if they win in November's election," the progressive advocacy group Social Security Works wrote in response to Rolling Stone's reporting. "Hell no. Hands off our earned benefits."
Philip Verhoef, president of Physicians for a National Health Program, told Rolling Stone that Project 2025's plan to make Medicare Advantage the default enrollment option would be "disastrous."
"To do so would be really just a clear handout to the private insurance industry," Verhoef said.
Project 2025 has said that it doesn't "speak for any presidential candidate," but Trump's reelection campaign has relied on parts of the coalition's proposed agenda for second-term planning.
Trump's team has faced backlash over some of Project 2025's work, including draft executive orders that would use the Insurrection Act to deploy the U.S. military against demonstrators. As The Washington Post reported in December, Trump campaign senior adviser Susie Wiles complained privately to Project 2025's director and asked the coalition to "stop promoting its work to reporters."
Seth Schuster, a spokesperson for President Joe Biden's reelection campaign, warned in a statement Monday that "if Donald Trump wins this November, he and Republicans will continue their push to end Medicare as we know it for millions of Americans."
"Trump will leave millions of seniors with fewer benefits and less access to doctors—all to benefit his big insurance donors," said Schuster. "In Trump's America, the special interests win and seniors and working families lose. Worse care, broken promises, and higher costs—that's Trump's plan for seniors and working families."
In addition to making Medicare Advantage the default enrollment option for Medicare, Project 2025 is calling for the revival of the Global and Professional Direct Contracting Model, a Medicare privatization scheme that the Biden administration rebranded as ACO REACH and slightly modified—to the dismay of physicians, healthcare campaigners, and progressive lawmakers who called for the repeal of the Trump-era pilot program.
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Report Shows Big Insurance Profiting Massively From Medicare Privatization
The seven largest for-profit insurance companies in the U.S. have seen their combined revenues from taxpayer-backed programs grow 500% over the past decade.
Feb 28, 2023
A new analysis released Monday shows that insurance giants are benefiting hugely from the accelerating privatization of Medicare and Medicaid, which for-profit companies have infiltrated via government programs such as Medicare Advantage.
According to the report from Wendell Potter, a former insurance executive who now advocates for systemic healthcare reform, government programs are now the source of roughly 90% of the health plan revenues of Humana, Centene, and Molina.
Over the past decade, Potter found, the seven top for-profit insurance companies in the U.S.—the three mentioned above plus UnitedHealth, Cigna, CVS/Aetna, and Elevance—have seen their combined revenues from taxpayer-backed programs soar by 500%, reaching $577 billion in 2022 compared to $116.3 billion in 2012.
"The big insurers now manage most states' Medicaid programs—and make billions of dollars for shareholders doing so—but most of the insurers have found that selling their privately operated Medicare replacement plans is even more financially rewarding for their shareholders," Potter wrote. "In addition to their focus on Medicare and Medicaid, the companies also profit from the generous subsidies the government pays insurers to reduce the premiums they charge individuals and families who do not qualify for either Medicare or Medicaid or who work for an employer that does not offer subsidized coverage."
Potter noted that the top insurance giants, a group he dubbed the Big Seven, now control more than 70% of the Medicare Advantage market, which has grown rapidly in recent years. According to the Kaiser Family Foundation, more than 28 million people were enrolled in a privately run Medicare Advantage plan last year—nearly half of the Medicare-eligible population.
An ardent critic of Medicare Advantage, Potter said in an interview with The American Prospect on Monday that the program "is a big contributor to the excessive spending" in Medicare.
"It needs to be ended," Potter, executive director of the Center for Health and Democracy, said of Medicare Advantage, whose major players frequently overbill the federal government and deny patients necessary care. The program is run by private insurers with government money.
"The premiums and taxes paid by Americans enabled the Big Seven to make those profits."
In his analysis, Potter observed that Medicare Advantage enrollment among the Big Seven increased 252% between 2012 and 2022.
Having deeply entrenched themselves in the Medicare program via Medicare Advantage, insurance giants are now looking to gain a foothold in traditional Medicare through a Biden administration pilot program known as ACO REACH, which has drawn mounting criticism from physicians and progressive lawmakers.
"We must fight the privatization of Medicare with every tool we have," Rep. Pramila Jayapal of Washington, chair of the Congressional Progressive Caucus, said in a statement last month.
When counting both their commercial businesses and participation in government programs, the Big Seven brought in $1.25 trillion in revenue last year and their profits rose to $69.3 billion, according to Potter, who emphasized that a growing share of insurance giants' revenues now comes from "the relatively new and little-known middleman between patients and pharmaceutical drug manufacturers" known as pharmacy benefit managers (PBMs).
"Cigna now gets far more revenue from its PBM than from its health plans," Potter noted. "CVS gets more revenue from its PBM than from either Aetna's health plans or its nearly 10,000 retail stores."
Potter lamented that "policymakers, regulators, employers, and the media have so far shown scant interest" in closely examining the taxpayer-reliant business practices of large insurance companies, which wield substantial lobbying power that they deploy against any effort to transform the United States' fragmented healthcare system.
"They've essentially been bailed out by taxpayers," Potter said of for-profit insurance giants. "And members of Congress, and various administrations, have been just standing on the sidelines, not paying attention to what's been going on."
Meanwhile, tens of millions of people in the United States are either uninsured or inadequately insured, and more than 100 million are saddled with healthcare-related debt.
A recent study by The Commonwealth Fund found that the United States spent close to twice as much as the average OECD nation on healthcare while achieving worse outcomes in critical areas such as life expectancy at birth and death rates for treatable conditions.
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Washington Post Runs Medicare Newsletter Sponsored By Insurance Lobby Front Group
The Jeff Bezos-owned newspaper sprinkled its coverage of an intensifying fight over Medicare with ads purchased by an organization that promotes private Medicare Advantage plans.
Feb 10, 2023
The Friday morning edition of The Washington Post's Health 202 newsletter featured coverage of the intensifying back-and-forth between the Biden administration and congressional Republicans over Medicare, with each side accusing the other of wanting to cut the program.
But the newspaper's ostensibly neutral, both-sides coverage of the high-stakes healthcare fight was interspersed with ads purchased by the Coalition for Medicare Choices, an innocuously named organization that serves as a front group for the private insurance industry's powerful lobbying group, America's Health Insurance Plans (AHIP).
The Post, owned by billionaire Jeff Bezos, states in the email version of its newsletter that the Friday coverage was "presented by" the Coalition for Medicare Choices, which bills itself as a "national grassroots organization" while acknowledging—in small font at the bottom of its website—that it's "powered by AHIP."
The large banner ad positioned at the top of the Post's newsletter features a senior accompanied by text that reads, "Don't Cut My Care."
The sidebar ad makes clear that the Coalition for Medicare Choices is concerned not about traditional Medicare, but about the finances of Medicare Advantage—a privately run program funded by the federal government.
The supposed "cut" highlighted by the ads refers to the Biden administration's 2024 payment plan for Medicare Advantage.
Insurance industry groups and their Republican allies in Congress claim that the payment proposal outlined by the Centers for Medicare and Medicaid Services (CMS) would result in a $3 billion cut to Medicare Advantage plans—a small fraction of large Medicare Advantage providers' annual revenues.
The Biden administration says the insurance industry and the GOP are "cherry-picking" numbers and insists the CMS plan would entail a limited increase, not a cut, in payments to Medicare Advantage plans, which are notorious for overbilling the federal government and denying patients necessary care. The federal government expects to pay more than $6 trillion to Medicare Advantage issuers over the next eight years.
CMS has also proposed a rule that would allow the federal government to claw back Medicare Advantage payments that were distributed improperly as a result of industry overbilling—a crackdown that the U.S. public overwhelmingly supports.
Republicans, who often conflate traditional Medicare and Medicare Advantage, have falsely described the new CMS rule as a Medicare Advantage cut.
"So-called 'Medicare Advantage' plans are not Medicare," Linda Benesch, communications director for the progressive advocacy group Social Security Works, told Common Dreams on Friday. "They are private plans run by corporations for the purpose of extracting as much money out of Medicare beneficiaries and the government as possible."
"Republicans, desperate to deflect from their own plans to cut Medicare, are claiming that limiting the annual increase in payments to these private plans is 'cutting Medicare,'" Benesch added. "Nothing could be further from the truth. By limiting the payments, the Biden administration is defending Medicare by slightly leveling the playing field between for-profit plans and actual Medicare. This is only a small first step. The Biden administration should do far more to regulate for-profit plans and protect Medicare beneficiaries."
Diane Archer, the president of Just Care USA and a senior adviser on Medicare at Social Security Works, added in a statement to Common Dreams that "to strengthen benefits and rein in costs for everyone with Medicare, President Biden and Kevin McCarthy should agree to end the tens of billions of dollars in overpayments to Medicare Advantage plans."
"The public strongly opposes this massive government waste and Medicare Advantage profiteering, as should policymakers on both sides of the aisle," Archer
"So-called 'Medicare Advantage' plans are not Medicare. They are private plans run by corporations for the purpose of extracting as much money out of Medicare beneficiaries and the government as possible."
It's hardly unusual for corporate media outlets in the U.S. to publish newsletters sponsored by business groups with a vested interest in the topic being covered, whether it's Medicare, drug prices, or Big Tech.
In October, the new media outlet Semafor sparked widespread derision and outrage by launching a climate newsletter sponsored by the oil giant Chevron, one of the world's biggest climate villains.
As The Lever noted in a 2021 look at the corporate-sponsored content of Punchbowl News and other publications, "These kinds of editorial choices are being made so frequently, they aren't even conscious decisions anymore—they are media culture."
"While it's not accurate to say there is an explicit newsroom quid pro quo in such editorial focus," the outlet continued, "it's also ridiculous to presume that all that cash from corporate sponsors has no influence at all."
The Coalition for Medicare Choices has been making use of the corporate media's embrace of sponsored content for years, placing its defenses of the fraud-riddled Medicare Advantage program and fearmongering about looming cuts in prominent outlets such as Politico.
In addition to touting the supposed benefits of Medicare Advantage, the insurance lobbying group that controls the coalition has lobbied aggressively against efforts to include hearing, dental, and vision coverage in traditional Medicare.
As The American Prospect's Robert Kuttner wrote in a column last week, "Medicare Advantage plans are popular and they are rapidly crowding out public Medicare" because they provide coverage that traditional Medicare doesn't, including hearing, dental, and vision.
Roughly half of the Medicare population was enrolled in a Medicare Advantage plan last year, according to the Kaiser Family Foundation.
"Despite the extra coverage ostensibly provided, studies have found that Medicare Advantage plans are more profitable than most other health insurance industry products, because of the opportunities they provide to game the system," Kuttner noted. "And that suggests that there is a much larger problem here that won’t be solved by a cat-and-mouse game of more aggressive audits—creeping privatization."
"Partial privatization insidiously leads to more privatization, leaving government to pay the added expense," he added. "Despite the promises of greater efficiency, it doesn't save costs but adds costs, as more money goes to industry middlemen and government has to spend more on monitoring... Medicare for All doesn't work if it includes privatized Medicare Advantage. Best to keep public programs public."
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Parroting Industry Talking Points, GOP Goes to Bat for Fraud-Riddled Medicare Advantage
"Medicare Advantage is private insurance," said Democratic Rep. Ro Khanna. "It profits by tricking patients into enrolling, and then denying them coverage."
Feb 09, 2023
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."
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