Trump’s America in 2025: Privatizing Medicare

The following is a statement from Biden-Harris 2024 Spokesperson Seth Schuster on Donald Trump’s close allies’ plans to privatize Medicare:

“Make no mistake – if Donald Trump wins this November, he and Republicans will continue their push to end Medicare as we know it for millions of Americans. Trump will leave millions of seniors with fewer benefits and less access to doctors – all to benefit his big insurance donors. In Trump’s America, the special interests win and seniors and working families lose. Worse care, broken promises, and higher costs – that’s Trump’s plan for seniors and working families.”

Key Point: “Such a policy would hasten the end of the traditional Medicare program, as well as its foundational premise: that seniors can go to any doctor or provider they choose. The change would be a boon for private health insurers — which generate massive profits and growing portions of their revenues from Medicare Advantage plans — and further consolidate corporate control over the United States health care system.

“It would not likely benefit seniors, since the private plans limit the doctors they can see and often wrongfully deny patients’ care. Because the plans are costly, experts say the GOP proposal could threaten the Medicare program’s solvency.”

Rolling Stone: Republicans Are Planning to Totally Privatize Medicare — And Fast

[Andrew Perez, 2/5/24]

• If Republicans win the presidential race this year, the push to fully privatize Medicare, the government health insurance program for seniors and people with disabilities, will only intensify.
• Conservative operatives have already sketched out what the GOP’s policy agenda would look like in the early days of a new Donald Trump presidency. As Rolling Stone has detailed, the proposed Project 2025 agenda is radically right-wing. One item buried in the 887-page blueprint has attracted little attention thus far, but would have a monumental impact on the health of America’s seniors and the future of one of America’s most popular social programs: a call to “make Medicare Advantage the default enrollment option” for people who are newly eligible for Medicare.
• Such a policy would hasten the end of the traditional Medicare program, as well as its foundational premise: that seniors can go to any doctor or provider they choose. The change would be a boon for private health insurers — which generate massive profits and growing portions of their revenues from Medicare Advantage plans — and further consolidate corporate control over the United States health care system.
• It would not likely benefit seniors, since the private plans limit the doctors they can see and often wrongfully deny patients’ care. Because the plans are costly, experts say the GOP proposal could threaten the Medicare program’s solvency.
• Under traditional Medicare, enrollees are free to visit any doctor who accepts Medicare (nearly all physicians do). Medicare Advantage plans, by contrast, often have limited networks of doctors that patients can choose from, and many providers have stopped accepting the private plans because they so often deny the prior authorization requests they require before patients can receive services.
• But the private plans often do not work well for sicker patients — and when they seek to leave the program and enroll in traditional Medicare, they may encounter an expensive problem: Most states allow Medigap plans to deny coverage to patients with preexisting health conditions, so these patients can get stuck with significant out-of-pocket costs.
• While Medicare Advantage plans are required to pay for services covered by traditional Medicare, the government has for years flagged “​​persistent problems related to denials of care and payment in Medicare Advantage.” More recently, news reports have found the private plans are using artificial intelligence and algorithms to deny services in bulk, with extreme error rates — allegedly as high as 90 percent, according to one class action lawsuit.
• The Biden administration has issued new rules and guidance to try to ensure that Medicare Advantage plans do as they are required and approve the same services as traditional Medicare. But the financial incentive to deny care is baked into the Medicare Advantage model: The private plans are given a fixed amount of money every month to provide coverage for each enrollee; paying out fewer dollars means extra profit.
• The privatized plans have, for years, systematically overbilled the government — mostly by billing the government as if their patients are sicker than they really are. The Biden administration has worked to claw back some of those past overpayments and rein in future outlays.