This summer, some lawmakers and outside experts floating As part of President Joe Biden’s huge multi-trillion dollar social expenditure, the idea of ??cutting Medicare Advantage funding to help cover the cost of adding dental, vision, and hearing insurance to Medicare that is charged for service plan.

It left the table almost as soon as it came up.Industry groups broadcast millions of dollars TV advertisement Warns senior citizens that Washington is “disrupting” their health care, and urges them to contact members and tell them “please don’t cut back on medical insurance advantages.”

Then Senator Christine Cinemas (D-Ariz.), whose support was essential to get Biden’s “rebuild better” package through the Senate, he wrote a copy letter Senator Tim Scott (RS.C.) touted the Medicare Advantage plan and vowed to “protect MA from salary cuts.”

In the end, these additional benefits—except for the hearing—are all due to Cost issue Moderate members such as Sinema and Sen. Joe Manchin (DW.Va.) said.

This is the power of the insurance industry in action. In recent years, Medicare Advantage operators in particular have escaped congressional scrutiny, even as a government regulator, Medical insurance expert and Ministry of Justice More and more worried about the problems they see in the program.

“The pressure from lobbyists on Congress is indeed considerable, which makes it politically difficult to change the medical insurance advantage, even if the money is recovered, it can be used for many other purposes,” said Donald Berwick, Health Care Improvement Research The co-founder of the institute has served as the administrator of the Medicare and Medicaid Services Center under the leadership of President Barack Obama.

Medicare Advantage is a fast-growing program created in 1997 by the Republican-led Congress and Democratic President Bill Clinton, namely Medicare+Choice. The goal is to provide beneficiaries with an alternative to traditional fee-for-service Medicare. It is hoped that private insurance companies can limit the cost of the plan.

It is estimated that by 2030, half of medical insurance beneficiaries will participate in private programs. Some experts, including the Medical Insurance Payment Advisory Committee, have long questioned whether the plan has good value to taxpayers. Despite the “relative efficiency” of health insurance advantages, MedPAC reported in June that it has never saved government money.

In fact, as more and more people enter the benefit period, medical insurance expenditures continue to grow, triggering new anxiety about the financial foundation of the plan. The medical insurance trustee predicts that the Part A trust fund will go bankrupt in 2026.

Despite this, the Medicare Advantage plan has been working hard to maintain the status quo, and most of it has been successful.

The industry often cracks down on lawmakers through advertising and lobbying campaigns that highlight the plan’s popularity among beneficiaries, in large part because these plans usually provide medical insurance that is not included in the fee-for-service coverage. The benefits include dental and vision insurance.

“They have become strong because 40% of the health insurance population participates in a managed health plan,” said Mark Miller, who served as the executive director of the Medicare Payment Advisory Committee for 17 years and now works at Arnold Ventures. “As far as insurance companies profit from it, the money can be used for lobbying.”

expert debate The Medicare Advantage plan can use risk adjustments to make patients look worse than they actually are, while benefiting from basic payments (called benchmarks) that have not been adjusted by Congress since 2010.

MedPAC says Congress should Lower benchmark Provide savings, and if the insurance company accepts smaller profits or improves efficiency, it can do so without affecting plan participation or beneficiaries’ access to supplementary benefits.

Plans that are lower than the benchmark bid will receive a partial rebate for the difference in supplementary benefits. These rebates account for 14% of payments made by CMS to Medicare Advantage plans in 2021.

In addition, the Office of the Inspector General of Health and Human Services Raise concerns In September, some Medicare Advantage companies may “inappropriately” use chart reviews and health risk assessments to maximize risk-adjusted payments.

OIG found that 20 of the 162 Medicare Advantage operators accounted for a disproportionate share of the $9.2 billion in diagnostic payments. These diagnoses are only reported in the chart view and health risk assessment, but not in other records .

MedPAC has been advising Congress for years to crack down on “overpayments” for Medicare Advantage plans, especially because it has to do with coding strength, which is estimated to cause $6 billion in plan improper payments each year.

Health insurance companies countered that they are more efficient at coding than the government, and their beneficiaries are actually more ill than the registrants who charge for services. The industry also raised objections to MedPAC’s conclusions.

Dan Jones, vice president of federal affairs for the Community Health Plan Alliance, said: “I don’t think the two parties are interested in making changes to the plan next year.” He said that most Medicare Advantage plans are “good stewards of federal taxation,” but there are some “Bad actors”.

Every year, dozens of lawmakers sign letters praising Medicare Advantage drafted by the industry instead of oversight.

70 members of Congress representing regions where the majority of Medicare beneficiaries have signed up to the Medicare Advantage plan letter in May.

More than 400 lawmakers-or three-quarters of Congress-signed a letter CMS “expressed strong bipartisan support for Medicare Advantage” in 2020, but did not raise questions about the integrity of the plan that the regulator has flagged.

“Part of the problem is the lack of education. These programs are privately run, and [lawmakers] Think about it,’This is all I need to know,'” said a congressional assistant whose boss refused to sign a similar letter. “We tend to stay away from many of them because we can see the inside story of what is going on. .

Educated members often come from groups such as the Better Medicare Alliance and AHIP, which are insurance industry groups that lobby for Medicare Advantage operators.

The Better Medicare Alliance was established in 2014, funded by insurance companies, and raised more than $6 million in 2020 to promote Medicare Advantage. According to the organization’s tax declaration, about one-third of it is used for communication, including advertising.

The coalition spent some of its funds this summer, and congressional Democrats are considering cutting plans so that they can use the funds for Biden’s social spending agenda. Some advertisements specifically mention senators who voted on key points in the program, including Manchin and Sinema.

These strategies are effective, said Wendell Potter, a former executive of Cigna, who now advocates health reforms. “Members of Congress don’t want to be accused of doing anything that damages the welfare of senior citizens, which is why the industry is so cautious in their advertising. Everything they do is to make people think that there is no difference between Medicare and Medicare Advantage,” he Say.

The Better Medical Insurance Alliance is also committed to gaining members’ favor through naming “Congress Champion” Who “supports the advantage of medical insurance”. In 2021, more than 400 lawmakers received this title in recognition of their “extraordinary dedication” to legislation supported by the coalition

Some of these “champions” are members of the House Fundraising, Energy and Commerce Committees, which have common jurisdiction over health insurance policies.

Some people were invited to speak at the group’s annual meeting. The top Republican Rep. Brett Guthrie (R-Ky.) of the Health Subcommittee of the Energy and Commerce Committee spoke at a meeting in October, calling private plans “better” than charging for service.

Representative Terri Sewell (D-Ala.), who serves on the fundraising committee, praised the Medicare Advantage plan for being “more personalized and specific” and providing “more flexibility and benefits.”

There is no mention of issues raised by MedPAC or others.

“Ignore this and they are not good stewards of taxpayer funds,” Porter said.

After Congress made changes in 2010 to generate Medicare savings, this lobbying offensive became more aggressive.

The insurance company later argued that these changes would harm their business and have a negative impact on the insured, but the facts are quite the opposite: Medicare Advantage’s number of insureds has exploded, and insurance companies have found more sources of income from the federal government. method.

“The industry will always say that if you do anything, it is a nuclear winter. But it is often not the case,” Miller said. “This industry may be more efficient and obviously shouldn’t be involved in upgrades and other practices. To allow this to continue is bad public management.”