Medicare Advantage (MA) payment rates for the coming year are released early in the prior year. As of this writing, the proposed 2025 rates are imminent. As noted in previous CMA Alerts (see, e.g., this one from 2020), release of this information coincides with the annual ritual of the insurance industry rounding up support on Capitol Hill for the MA program and loudly protesting any proposed reductions in MA payment rates.
A March 22, 2023 article in the New York Times titled “Biden Plan to Cut Billions in Medicare Fraud Ignites Lobbying Frenzy” by Reed Abelson and Margot Sanger-Katz documented last year’s insurance industry lobbying efforts to reverse minor payment changes to MA plans, then proposed for 2024. The article noted that there is “weaking support in Congress” for MA plans, in the wake of “widely publicized lawsuits, audits and reviews” which influenced lawmakers’ conduct:
Last year, nearly 80 percent of the members of the House of Representatives signed a letter to Medicare urging its officials to “provide a stable rate and policy environment for Medicare Advantage.”
But this year, support among lawmakers appears to have weakened, despite the avalanche of constituent calls. So many legislators would have dropped from the House letter that the insurance industry has declined to circulate one, several congressional aides said. That shift came in part from increasing awareness of overbilling, but also because of concerns about deceptive marketing and denials of care, they said.
Last year, as touted by industry group Better Medicare Alliance, a Medicare Advantage support letter urging the Centers for Medicare & Medicaid Services (CMS) to “provide a stable rate and policy environment” for the industry did emerge from the Senate with 61 senators signed on.
A similar industry-friendly letter urging “payment and policy stability for the Medicare Advantage program” is currently making the rounds in the Senate.
In a letter to senators urging them not to sign the industry letter, Physicians for a National Health Program (PNHP) highlights how “egregious and misleading” the industry letter is. Among other things, PNHP notes that the industry letter provides no evidence for the claim that there are “‘better health outcomes’” among MA enrollees, and states that the higher penetration of MA into disenfranchised communities actually contributes to disparities and inequities in health care.”
The Center for Medicare Advocacy supports PNHP, Social Security Works, Public Citizen, Be a Hero and other organizations that are dedicated to serving beneficiaries rather than private plans in their efforts to urge senators not to sign this industry letter. Instead of promoting “payment and policy stability” for the insurance industry – which would continue wasteful overpayments to MA plans and prevent CMS from instituting further needed consumer protections surrounding inappropriate denials and delays in care, widespread marketing misconduct and narrowing provider networks, among other issues – policymakers should focus on how best to ensure that MA enrollees and all Medicare beneficiaries have access to the care they need. Promoting and protecting the status quo fails this goal.
January 18, 2024 – D. Lipschutz