AMHERST — Mindful that tens of billions of dollars will go to for-profit insurance companies rather than paying for seniors’ critical medical needs, Valley Action in Amherst and other regional activist groups are calling for stronger rules to guide and reform the Medicare Advantage program.
Valley Action is among a coalition of Massachusetts and New York-based chapters of Indivisible, a progressive movement that began in 2016 and has submitted a large number of comments to the Centers for Medicare and Medicaid Services, which regulates Medicare Advantage. The groups are demanding that insurers stop delaying and denying care when enrollees become very sick, that rules be put in place to ensure quality and timely care and that people have greater control over their Medicare dollars.
Activist groups contend that a litany of existing problems with Medicare Advantage would not be addressed by the reviews the agency is considering, nor are they enough to stop taxpayer fraud. These problems consist of making access to care more difficult, limiting the number of providers they can use, and possibly requiring referrals.
“We want people to tell CMS that the proposed rules are woefully inadequate and do not address the problem,” said Elaine Fronhofer, an Amherst attorney who co-founded Valley Action.
Instead, Fraunhofer said, there needs to be a complete revamp of what they see as theft by private insurers, dubbed “Big Health” by critics, that offer Medicare Advantage plans.
While traditional Medicare is run by the government, only Medicare Advantage is regulated by the government. Private insurance company plans cover all services in Medicare Part A (hospital costs) and Part B (practitioner services), while also offering additional benefits such as dental, vision, and hearing coverage, as well as prescription drugs. Customers generally pay lower premiums than they would for traditional Medicare and get this additional coverage.
In a blurb on its website, Valley Action wrote that “profit-seeking insurance companies have been defrauding taxpayers by abusing the Medicare Advantage program, which allows insurance companies to provide Medicare-like insurance to seniors. These companies are paid by the government out of pocket.” Taxpayers that were traditionally used to pay for medical care.
Valley Action, as an Indivisible group, was asked to help work on the issue by Olive Action of Ulster County, another Indivisible group based in New York state, Fronhofer said.
Providing comments to CMS during the public comment period is a “not-to-be-missed opportunity for the public to act as a counterweight to well-funded industry lobbyists,” Fraunhofer said. Valley Action and other Indivisible companies are also planning more actions directed at elected and appointed officials.
Valley Action also signed a letter, along with Indivisible Northampton-Swing Left Western Mass. And the continuing political revolution in Franklin County, both in the district of U.S. Rep. Jim McGovern, and others in the district of U.S. Rep. Richard Neal.
This letter states: “We are sending this letter to you today calling on the Centers for Medicare and Medicaid Services (CMS) to do everything it can to help traditional Medicare solvency and protect Americans from being harmed by for-profit insurance companies that offer Medicare Advantage plans to older adults and people People with disabilities.
The letter cites recent National Health Policy Physicians estimates that Medicare Advantage insurers overcharge taxpayers by as much as $140 billion annually and deprive 18% of what traditional Medicare would cover, most often for cases requiring skilled nursing colonoscopy, And specialized examinations. Caring for various types of cancer.
Meanwhile, a bipartisan letter from four U.S. senators was sent in December to CMS Director Chiquita Brooks-LaSor.
“Researchers report overpayments in the billions,” wrote Massachusetts Democratic Sen. Elizabeth Warren, joined by Sen. Catherine Cortez Masto, D-Nevada, Sen. Bill Cassidy, R-Los Angeles, and Sen. Marsha Blackburn, R-Tenn. . For Medicare Advantage Plans, Driven Largely by Preferred Selection and Shortcomings of the Current Risk Adjustment Model Between 2010 and 2019, CMS paid Medicare Advantage plans at least $106 billion in overpayments.
The four senators have also introduced legislation to improve the transparency of Medicare Advantage plans and ensure that these plans best serve the health care needs of America’s seniors. The Frontline Data Enhancement Act would require Medicare Advantage plans to report important information about how much they actually pay for patient services and how much patients are responsible for paying out of pocket.
“For years, Medicare Advantage plans have used a long list of tricks to overcharge the government for coverage, while delaying and denying care to seniors,” Warren said in a statement. “By promoting data transparency, this bipartisan bill will enable lawmakers and regulators to rein in this fraud and abuse, and ensure taxpayer dollars are used to deliver high-quality coverage to Medicare beneficiaries.”
While the deadline for submitting comments to CMS was last Friday, the Valley Action Group is holding an in-person meeting on January 18 from 6:30-8:30pm at the Bangs Community Center, Room 101, where additional steps will be discussed.
Scott Merzbach can be reached at smerzbach@gazettenet.com.