Hearing on Medicare Advantage: Past Lessons, Present Insights, Future Opportunities
House Ways and Means Subcommittee on Health
2025-07-22
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Source: Congress.gov
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The joint hearing of the health and oversight subcommittee will come to order. Good morning and thank you to the witnesses for being here today to discuss an important issue, Medicare Advantage or MA. MA is a very popular health insurance option that plays a vital role in providing high-quality, affordable care to millions of seniors, including over 100,000 from my district in Florida. Nationwide, 54% of Medicare beneficiaries choose MA plans over traditional fee-for-service Medicare plans. In Florida, 60% of Medicare beneficiaries are enrolled in MA. MA beneficiaries spend less on care and have a better health outcome than those that do a traditional Medicare, leading to lower and more efficient costs across the system. MA beneficiaries generally also have more access to benefits traditionally Medicare doesn't offer, low-cut, lower out-of-pocket costs, vision, dental, hearing coverages, prescription drugs, prevention services, and chronic diseases, management care, and a host of other supplemental benefits. I'm very excited about the supplement benefits MA provides to improve health and wellness, such as access to fitness memberships, wearable technologies, and health meals optional. 95% of MA beneficiaries are satisfied with the care they receive. It's important to examine the program to ensure MA continues to deliver for patients. For example, we have heard many stories of excess prior authorization and payment delays that negatively impacts patients.
Outdated financial incentives may also contribute to some of the unjustifiable payments in the MA program. Fortunately, we have the ability to modernize the benefits to ensure patients receive the best care, reduce burden on providers, and better manage overall health care costs. Transparency is crucial for maintaining a trust in the system and ensuring efficient use of taxpayer dollars. I believe we can protect the integrity of MA while ensuring it remains a strong option for beneficiaries. I look forward to discussing the opportunities today with our witnesses. I hope all my colleagues will focus on the topic at hand. Now, I'm pleased to recognize the gentleman and my good friend from Texas, Mr. Doggett, for his opening statement.
Well, thank you very much, and thank you, Mr. Schweikert, as well. I am very pleased that these committees are finally addressing some genuine waste, fraud, and abuse. Early in the reconciliation process, I led several colleagues in urging the Republican leadership to focus on waste in the Medicare Advantage program rather than cutting coverage. While that request was unanswered, today we have an opportunity to start paving a new bipartisan path toward fiscal responsibility. a path that protects both taxpayers' hard-earned dollars and their access to care. Medicare Advantage was sold as a program to save taxpayer dollars and improve the quality of care, but I found that it is largely a disadvantage, never saving taxpayers a penny and vastly outspending traditional Medicare. While some of us have differing views concerning MA and its position in the future of health care for seniors and individuals with disabilities, I know we are all concerned with wasteful overpayments and assuring the long-term promise of Medicare for future generations. The Nonpartisan Independent Medicare Payment Advisory Commission, or MedPAC, estimates that taxpayers will spend 20% more this year for people in Medicare Advantage than if they had been enrolled in traditional Medicare. That amounts to $84 billion this year alone. And these funds don't just impact Medicare's long-term finances. Every single enrollee is paying an average of $198 more in Part B premiums this year because of overpayments to MA insurers. What are consumers getting for all this money? While outrageously, many are just facing care delays and denials, fewer and fewer provider options, and poor consumer service. For providers, MA is becoming more trouble than it's worth. An Austin surgeon, Dr. Elizabeth Potter, was pulled out of surgery to talk to UnitedHealthcare representatives about an authorization she'd already received for the procedure she was in the middle of performing.
When she fought back, United sought to discredit her and is denying coverage for her surgery center, driving her into debt as she turns to a GoFundMe page to keep her practice afloat. Stories like hers are why I've urged the Justice Department to expand the investigation into United to closely examine every allegation of fraud, waste, and abuse, including reported denials of necessary hospitalizations. For years, I've heard from hospitals, home health care providers, and other professionals who are experiencing increasing administrative burdens, delays in reimbursement, and smaller payments that are falling below what traditional Medicare would have paid. Together with my colleague, Dr. Murphy, we've authored the Prompt and Fair Pay Act, bipartisan legislation that we filed this week to ensure MA plans at least pay what traditional Medicare pays for covered items and services. Our bill also establishes prompt payment requirements modeled after the requirements in Part D. It has been endorsed by the National Rural Health Association, LeadingAge, America's Essential Hospitals, the American Academy of Family Physicians, the American College of Physicians, and a number of others. Last month, we also filed bipartisan legislation in which Chairman Schweikart participated to address an outrageous loophole that permits Medicare Advantage plans to receive premiums and capitated payments from duly eligible veterans. receive most or sometimes all of their care through the VA. Researchers have estimated that this loophole will cost the VA over $350 billion over the next decade as taxpayers really are paying for care twice. Once to the MA insurer who pockets the money and a second time to the VA which actually delivers the care that it is wrongly prohibited from recouping its cost from the insurer.
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