Wall Street Cheers, Senior Citizens Cry as Biden Fails on Medicare
“It is now clear that Medicare Advantage is simply a profiteering venture that hurts patient care.”
By Jake Johnson
UnitedHealth Group, a dominant force in the lucrative Medicare Advantage market, has seen its stock jump over the past week as Wall Street analysts and investors embrace the Biden administration’s decision to delay reforms aimed at tackling abuse in the privately run, government-funded health program.
STATreported late last week that “Wall Street was overjoyed” by the announcement from the Centers for Medicare and Medicaid Services (CMS), which said it would phase in changes to the model that dictates how much government funding Medicare Advantage insurers receive to cover patient care.
Instead of implementing the changes all at once, the Biden administration will roll out the reforms over a three-year period, allowing Medicare Advantage insurers to continue overbilling the federal government in the meantime.
Recent federal audits and investigative reports have detailed how Medicare Advantage plans overcharge the government to the tune of billions of dollars a year by making patients appear sicker than they are, piling on diagnoses with little to no supporting documentation. Medicare Advantage plans also frequently deny necessary care and use algorithms to prematurely end coverage.
In addition to delaying full implementation of its reforms, CMS—which has faced aggressive lobbying from UnitedHealth and other major Medicare Advantage players in recent weeks—announced it would boost payment rates for Medicare Advantage plans by 3.3% in 2024—a larger-than-expected increase.
CMS said Medicare Advantage payments would rise by nearly $14 billion next year under the new plan.
As STAT‘s Bob Herman noted, “health insurance companies that participate in Medicare Advantage will retain billions of extra taxpayer dollars next year” thanks to the Biden administration’s changes, which drew criticism from progressive lawmakers and some policy experts.
“The phased-in approach will continue to reward those insurers with the most abusive practices over the next two years,” warned Mark Miller, executive vice president of healthcare for the philanthropy Arnold Ventures.
Herman reported that following the CMS announcement, “investors raced to buy stocks of the largest Medicare Advantage insurers, including UnitedHealth, Humana, CVS Health, Elevance Health, and Centene.” STAT cited one analyst estimate suggesting that UnitedHealth Group could see $900 million in additional profit next year thanks to the CMS policy revisions.
“It was ‘a sigh of relief’ for the industry, according to Jailendra Singh, a healthcare stock analyst at Truist Securities,” Herman wrote. “Chris Meekins, a health policy analyst at Raymond James, called the White House’s move ‘a clearing event for the space.'”
The Medicare Advantage rule that phased in coding changes was a “sigh of relief” for health insurers. Even CMS admitted the delay will benefit insurers’ bottom lines. As @Michael_Chernew told me: “The sky is not falling, and in fact more needs to be done.” https://t.co/KnNbyCwqZO— Bob Herman (@bobjherman) April 7, 2023
UnitedHealth, Cigna, Humana, CVS/Aetna, Elevance Health, Centene, and Molina have seen their combined revenues from taxpayer-funded programs like Medicare Advantage soar from $116.3 billion in 2012 to $577 billion in 2022, according to a recent analysis by Wendell Potter, a former Cigna executive who now heads the Center for Health and Democracy.
Those companies have been at the forefront of what The New York Times recently described as a “lobbying frenzy” on Capitol Hill, a blitz that appears to have influenced the Biden administration’s decision to go easy on Medicare Advantage despite promising bold reforms.
The Times noted that the administration’s earlier proposals to revise the Medicare Advantage risk-adjustment model “unleashed an extensive and noisy opposition front, with lobbyists and insurance executives flooding Capitol Hill to engage in their fiercest fight in years.”
“The largest insurers, including UnitedHealth Group and Humana, are among the most vocal, according to congressional staff, with UnitedHealth’s chief executive pressing his company’s case in person,” the newspaper reported. “Since the proposal was tucked deep in a routine document and published with little fanfare in early February, Medicare officials have been inundated with more than 15,000 comment letters for and against the policies, and roughly two-thirds included identical phrases from form letters.”
The Better Medicare Alliance, a lobbying organization backed by top Medicare Advantage insurers, purchased a Super Bowl ad decrying the Biden administration’s earlier reform proposals as an effort to “cut” Medicare Advantage.
Rep. Pramila Jayapal (D-Wash.), chair of the Congressional Progressive Caucus, said in a statement late last week that she was disappointed by the Biden administration’s decision to weaken its reforms in the face of industry pressure.
“It is now clear that Medicare Advantage is simply a profiteering venture that hurts patient care,” said Jayapal. “Without a complete overhaul, it will be impossible to stop bad actors. These plans have spent years scamming seniors and overcharging the government to pad their own profits. We were on the cusp of immediate reform when the Biden administration proposed fixes to stop price gouging by insurance companies.”
“Sadly,” she added, “health insurance companies used taxpayer dollars meant for medical care to instead buy Super Bowl commercials and desperately lobby to stop these changes that would cut down on their profiteering.”
Published by Common Dreams, 04.10.2023, under the terms of a Attribution-NonCommercial-NoDerivs 3.0 Unported license.