Television ads show seniors playing tennis, golf and riding motorcycles. In other examples, senior celebrity pitchmen, including actor William Shatner, NFL star Joe Namath and former Republican Gov. Mike Huckabee of Arkansas, have promised new perks along with photos of their government-issued ID cards. are.
These are all Medicare Advantage ads, and Americans may see even more of them if Donald Trump wins the White House.
That's because one of the details of the Republicans' only health care policy involves further privatization of the program, or selling more of the plans promoted in these commercials.
“We groan when we think of (Medicare) Advantage as insurance,” says Karen Kinsel, the only physician in Fort Gaines, Ga., a rural area where more than a third of the population lives below the poverty line. the doctor said.
Medicare Advantage is private insurance paid for by the federal government, a program authorized in 1997 amid concerns about Medicare costs. Insurance companies promised cheaper plans with better benefits.
One of the most important differences for patients is that Medicare Advantage plans have a “network” charge, meaning they limit the number of doctors and hospitals a patient can see at a discounted rate. Traditional Medicare does not include networks. 98% of U.S. providers participate. However, traditional Medicare has a monthly cost, with most people paying a standard rate of $174.70.
Medicare Advantage plans can be attractive because they often include meal and transportation cards, $0 monthly premiums, and hearing, vision, and dental benefits not included in traditional Medicare. there is.
Kinsel points out that the problem usually begins when people get sick.
“Patients are no longer able to enter and remain in rehab facilities,” she said. Some people were charged $50 a day for rehabilitation, even though rehabilitation is usually free for a short period of time under traditional Medicare.
“We've spent a lot of time in our district offices with seniors who were fooled by these commercial insurance plans,” said Democratic U.S. Rep. Pramila Jayapal of Washington state. Jayapal called for “urgent reform” and adding consumer protections to Medicare Advantage.
“Seniors think they are actually enrolled in Medicare because they took the name,” she says.
Despite complaints from doctors and patients, investigations into fraud, allegations that insurance companies used artificial intelligence models to deny care to older adults, and mounting evidence that Medicare Advantage costs taxpayers more. Republicans have continued to strengthen this program. The most concrete health policy proposals are contained in Project 2025, a conservative strategy by the Heritage Foundation.
Amid complaints, including mandatory vaccinations and more than 199 mentions of abortion, the document also proposes further privatization of Medicare through Medicare Advantage.
Project 2025 claims that Medicare Advantage “offers beneficiaries a wide selection of competitive health plans, offering greater benefits than those offered by traditional Medicare at a reasonable cost.” The document says Republicans should make this the default enrollment option and “remove burdensome policies that micromanage” the plan.
They took the name – so seniors think they are actually enrolled in Medicare.
Pramila Jayapal, USA representative
The document also proposes “giving beneficiaries direct control over how their Medicare money is spent,” which Democrats claim describes the voucher program, which Republicans pushed under the Trump administration. That's what I tried to do.
“This has been the strategy for privatizing Medicare since the beginning of the corporate Medicare 'disadvantage' plan (as I call it),” Jayapal said. “It was their intrusion.”
Like many of Donald Trump's proposals, this would likely cost the federal government a lot of money.
“The federal government significantly overpays for Medicare Advantage plans compared to what it spends on individuals and traditional Medicare; “I don't see any significant benefit in doing so.”
According to the Medicare Payment Advisory Council, a nonpartisan research organization commissioned by Congress, research shows that without corresponding health improvements, Medicare Advantage plans will cost the federal government an estimated $83 billion more than traditional Medicare in 2024. It will cost many dollars more. Using default registration could increase that cost to an additional $2 trillion over 10 years, according to the left-leaning Center for American Progress.
The stakes of private health insurance companies are equally enormous. United Healthcare, one of the largest providers of Medicare Advantage, earned 46% of its $281 billion in total revenue even though Medicare Advantage enrollees accounted for only 15% of its beneficiaries. According to an analysis by Accountable.US. This analysis was shared exclusively with the Guardian.
“The fact that this is becoming something that conservatives are trying to promote as a universal model is alarming because it's just a way to increase profits for insurance companies,” said Tony, Accountable.US Executive Director.・Kirk said.
Problems with the program are so severe that at one point in 2022, eight out of the 10 largest insurance companies selling Medicare Advantage plans were defendants in federal fraud or whistleblower lawsuits.
“Part of the problem with introducing private plans into Medicare, or really any area of health care, is the promise that we can provide better care more efficiently,” Lipshutz said. “And neither of those things are happening.”
While former Republican deficit hawks may balk at such a price, the proposal to further privatize Medicare is based on a longstanding Republican philosophy that survived Trumpism. The idea is that governments are inherently untrustworthy and that ordinary people need economic reasons to do the right thing.
“The problem with the left is that they don't think in economic terms,” says economist John Goodman, who has advised nearly every Republican presidential candidate since George W. Bush on health. He said he is currently working with the America First Policy Institute, a pro-Trump think tank.
Philosophically, Goodman believes Americans need “economic incentives” to do the right thing.
For patients, such as those with diabetes, that may mean low-cost insulin (the carrot), but it also means the fear of a hefty bill (the stick) if they can't manage their diabetes and end up in the hospital. I might. For doctors, that may mean jumping through bureaucratic hoops to get approval for a procedure called prior authorization to avoid waste.
Critics argue that talk of “economic incentives” actually masks “catastrophic” health care costs. Medicare Advantage plans are allowed to require patients to spend up to $13,300 annually with out-of-network providers in 2024. According to the Commonwealth Fund, more than one-third of all Medicare Advantage enrollees live on less than $10,000 a year. According to the National Council on Aging, nearly 95% of all older adults have a chronic health condition, and more than 78% have two or more chronic health conditions.
Although President Trump denies Project 2025, he has deep ties to its creator. That health proposal was written by Roger Severino, former director of the Office of Civil Rights at the Department of Health and Human Services.
In particular, Goodman believed that Project 2025 was a “poor document” that included too many references to abortion and was likely to alienate voters. But he agrees with the Medicare proposal.
President Trump promised in his 2024 Republican platform that he would “not cut a single penny from Medicare,” but provided no further details. This is in line with the Project 2025 plan. The Project 2025 plan calls for more funding to expand Medicare Advantage enrollment.
For Goodman, there is at least one element of humor in this area of health policy. The idea is that the left proposes a health care system where people don't have to pay for health care.
“In fact, Bernie Sanders-type people don't think economic incentives should play any role in health care,” Goodman said.
