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The Truth Behind Medicare (Dis)Advantage's Disinformation Campaign | Opinion


Right now, Big Insurance is descending on Capitol Hill with millions of dollars and an army of lobbyists and ad campaigns to spread disinformation about Medicare Advantage, or as we like to call it Medicare (Dis)Advantage. It is part of the industry's annual push to drum up congressional support for a program that uses taxpayers' dollars to line the pockets of corporate insurance executives and increase their already sky-high profits—profits that are made off of the backs of taxpayers when insurance companies fraudulently make their enrollees look sicker than they really are to get more money from the government—up to $156 billion per year.


But here is the truth, plain and simple: Medicare Advantage is neither Medicare nor an advantage. It is a scam promoted by large insurance companies like UnitedHealth hiding behind the name of a trusted program.


The trouble for Big Insurance is that more and more lawmakers are coming to this conclusion. And as support for Medicare Advantage on Capitol Hill begins to decrease and demands for reform become louder, Big Insurance, in a desperate attempt to stop the bleeding, has doubled down on its disinformation campaign.


Since sunlight is the greatest disinfectant, let's look at the claims these corporations are making to Congress.


First off, the industry claims that Medicare Advantage plans reduce costs. But this is simply not true. Unfortunately, Medicare Advantage has never saved the taxpayers money. In fact, the opposite is true. Spending per beneficiary is growing faster in Medicare Advantage than in traditional Medicare with no increases in quality of care.


And it gets worse. While Big Insurance touts the coverage Medicare Advantage plans provide, the reality is Medicare Advantage plans often provide worse coverage than traditional Medicare.In fact, recent data has shown that the worst five percent of Medicare Advantage plans are responsible for 10,000 preventable deaths every single year. And a recent study published in the Journal of Clinical Oncology found that people with Medicare Advantage plans are significantly more likely to die in the month following surgery for stomach, pancreatic, or liver cancer compared to people in traditional Medicare.


Another important characteristic of Medicare Advantage plans is their aggressive use of tools to delay and deny care such as prior authorization, which is seldom used in traditional Medicare, and rarely for services like physician-administered cancer treatments (no one wants chemotherapy if they don't need it). Studies have shown that 99 percent of Medicare Advantage plans require prior authorization for prescribed treatments. If your doctor says you need care, that should be the end of it, not the beginning of a series of expensive hoops to jump through because insurers want to increase profits.


It's unconscionable for Medicare Advantage plans to delay care through unnecessary prior authorization red tape and then still charge high out-of-pocket costs after a doctor has confirmed a patient needs physician-provided therapies.


Medicare Advantage plans also drive health inequalities, contrary to Big Insurance claims. These private insurance plans target people of color to enroll in Medicare Advantage plans that offer inferior care. Unfortunately, the shiny but paper-thin benefits Advantage plans use to reel in unsuspecting seniors and people with disabilities attract patients of color and low-income patients because they offer small upfront cost savings. Then the private insurance plans pull a bait and switch and delay and deny care for their mostly BIPOC patient pools thus worsening health disparities.


And the industry's biggest and boldest piece of disinformation is that Medicare Advantage plans will be forced to cut benefits if the government stops massive overpayments that have been padding corporate profits for decades.


This is wholly false. And you want to know how we know? Because we have reduced overpayments before.


After the Affordable Care Act reduced overpayments, there were no decreases in access to care or increases in costs for Medicare Advantage beneficiaries. Of course, curbing overpayments would, however, rein in excessive profit margins made on the backs of taxpayers, which have allowed private Medicare Advantage insurers to more than double their profit margins per enrollee.


Insurance companies don't want you to know that by stopping these overpayments, we could fully pay for massive improvements to Medicare including expanding benefits to include dental, vision, and hearing care, establishing a low cap on out-of-pocket spending for everyone in Medicare, or lowering the Medicare age. In fact, in a memo, now removed from the internet, commissioned by America's Health Insurance Plans (AHIP), they confirm that if dental, vision, and hearing benefits were added to Medicare with no additional funds given to Medicare Advantage companies, the companies would still have rebate dollars left over after paying for their members' care.


Hence, the disinformation campaign.


And this disinformation campaign is not limited to the halls of Congress. Talk to seniors in Seattle or Lake Forest Park or Shoreline–or any community, for that matter–and they will tell you about their struggles with Medicare Advantage, whether it be the relentless and misleading advertising campaigns or how hard they make it to get care.


Sensible reforms can fix many of the problems of Medicare (Dis)Advantage, bring better care to our seniors and people with disabilities, and decrease health inequities. But Big Insurance has fought them at every turn.


It's time for the disinformation to stop and the truth to come out. And it's time for Congress and the administration to implement sensible reforms to the program. Seniors in this country deserve a comprehensive, sustainable Medicare program that serves patients' needs, not corporate profits.


Authors: Pramila Jayapal and Wendell Potter

Jayapal represents Washington's 7th congressional district in the United States House of Representative and Potter is former VP, corporate communications, Cigna, and publisher of HEALTH CARE un-covered.

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