In an effort to crack down on the misleading practices of Medicare Advantage providers, Democratic Reps. Mark Pocan, Ro Khanna, and Jan Schakowsky reintroduced legislation Tuesday that would ban private insurers from using the "Medicare" label in the names of their health plans.
The legislation, titled the
Save Medicare Act, would formally change the name of the Medicare Advantage program to the Alternative Private Health Plan, an attempt to make clear to seniors that the plans are run by private entities such as Anthem, Humana, Cigna, and UnitedHealthcare.
"Only Medicare is Medicare," Pocan (D-Wis.)
said in a statement. "It is one of the most popular and important services the government provides. These non-Medicare plans run by private insurers undermine traditional Medicare. They often leave patients without the benefits they need while overcharging the federal government for corporate profit."
Khanna (D-Calif.) declared that "it's time to call out 'Medicare Advantage' for what it is: private insurance that profits by denying coverage and the name is being used to trick seniors into enrolling."
"That's not right," he added. "This bill will end the scam by preventing private insurers from profiting off the Medicare brand. Our focus should be on strengthening and expanding real Medicare."
The bill, which faces long odds in the Republican-controlled House, was introduced as GOP lawmakers
push for cuts to traditional Medicare as part of their broader austerity campaign.
It also comes as the Biden administration is moving ahead with a Medicare privatization scheme known as
ACO REACH, a pilot program that critics warn could fully engulf traditional Medicare in a matter of years.
The Democratic trio's legislation does not specifically address ACO REACH, opting to zero in on Medicare Advantage plans that are notorious for denying necessary care to vulnerable seniors and overbilling the federal government.
The measure would impose a $100,000 penalty each time a private insurer uses the Medicare name in the title of one of their plans.
"So-called Medicare Advantage is neither Medicare nor an advantage. It is simply another scheme by the insurance companies to line their pockets."
Earlier this week, the Biden administration proposed a
new rule that would strengthen audits of Medicare Advantage plans, which are paid an annual per-person rate by the federal government. Recent investigations have exposed how Medicare Advantage plans frequently overcharge the government by making patients appear sicker than they are, resulting in a higher payment.
The federal government currently
expects to pay Medicare Advantage providers more than $6 trillion over the next eight years.
"Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people,"
Kaiser Health News reported in December. "But federal officials rarely demand documentation to verify that patients have these conditions, or that they are as serious as claimed. Only about 5% of Medicare Advantage plans are audited yearly."
Medicare Advantage has
grown rapidly over the past decade, with more than 28 million people in the U.S. enrolled in such plans as of 2022. MA plans often provide coverage for hearing, vision, and dental—benefits not offered by traditional Medicare, despite the efforts of progressive lawmakers to expand the program.
Some Democratic lawmakers have warned that part of the massive growth rate of Medicare Advantage plans could be due to their deceptive advertising practices.
In November, Senate Finance Committee Chair Ron Wyden (D-Ore.) released an
investigative report laying out evidence of a range of "predatory actions" by private insurance companies that offer Medicare Advantage plans.
"Agents were found to sign up beneficiaries for plans under false pretenses, such as telling a beneficiary that coverage networks include preferred providers even when they do not," the investigation found. "Of particular concern to the committee were reports across states of agents changing vulnerable seniors' and people with disabilities' health plans without their consent."
Wendell Potter, president of the Center for Health and Democracy, said Tuesday that "so-called Medicare Advantage is neither Medicare nor an advantage."
"It is simply another scheme by the insurance companies to line their pockets at the expense of consumers," said Potter, a former health insurance executive with
first-hand experience of the industry's misleading practices. "I applaud Congressman Pocan and Congressman Khanna for introducing this vital legislation. The healthcare market is confusing for consumers and misleading branding like so-called Medicare Advantage just makes it worse."
