H.R. 3467 Stinks

Here are the three provisions in the bill that are the most glaringly harmful to seniors, taxpayers and the free market.

H.R. 3467, or the euphemistically titled Medicare Advantage Reform Act, was introduced last month by Rep. David Schweikert (R-Ariz.). It’s terrible legislation. About as tone deaf and harmful as a bill could get. But it would throw a lifeline to America’s for-profit health insurance corporations, which have seen their stock prices plummet in recent months, so you know who’s behind it.

Long story short, the crux of the bill is this: Help Medicare Advantage insurers rob Americans of choice and funnel more taxpayer dollars through the Wall Street-owned Medicare Advantage insurers.

Below, I’ll highlight the three provisions in the bill that are the most glaringly harmful to seniors, taxpayers and the free market. 

1. Wall Street by Default: Automatic Enrollment

H.R. 3467 would automatically enroll millions of Americans into a Medicare Advantage plan they didn’t choose, starting in 2028. Here’s how it works: Anyone who qualifies for Medicare Part A and enrolls in Part B will be shunted straight into the “lowest-cost” Medicare Advantage plan in their area. But regardless of price point, Medicare Advantage plans are riddled with shortcomings. Reporting shows that MA plans have high rates of prior authorization; narrow networks; and care denials. 

Take the story of Gary Bent as an example: Under the care of his daughters, Bent died after an artificial intelligence program used by his Medicare Advantage plan denied him admission into a rehab facility following brain surgery. 

The decision to, by default, feed American seniors into the Medicare Advantage machine (especially with renewed scrutiny into Medicare Advantage business practices by the Department of Justice, Congress and the media), is questionable at best.

2. ‘Can’t Choose Your Doctor’: Mandatory Continuous Enrollment

If auto-enrollment isn’t bad enough, as Diane Omdahl highlights in Forbes, H.R. 3467 goes a step further and locks seniors in to Medicare Advantage for three years. If enacted, seniors would be forced to stay in a Wall Street-controlled Medicare Advantage plan for 1,095 days before being eligible to transfer to traditional Medicare. 

The ruby-est red of red herrings in the insurance industry’s propaganda script book has always been the “you can’t choose your doctor” trope — a scare line health insurers deployed during the debate on what became the Affordable Care Act (and other patient-friendly reforms). But the bitter irony is that this bill would make insurance companies richer by prohibiting American seniors from jumping ship – even if the insurer drops their doctor, narrows their networks or hikes their premiums.

Speaking of Forbes:

I was pleased to see Steve Forbes, the Chairman & Editor-In-Chief of Forbes Media, note Medicare Advantage’s incredible cost to taxpayers and shortcomings to American seniors on X.

3. A New Way To Pay Themselves: Forcing Hospice into Medicare Advantage

Another piece of the bill that deserves more attention: H.R. 3467 would force hospice care to be covered by Medicare Advantage – a move that will trample independent hospice providers and be a windfall for big Wall Street-controlled health insurers.

Over the last decade, health insurance giants (like UnitedHealth Group and CVSHealth/Aetna) have vertically integrated. They don’t just sell Medicare Advantage plans anymore. They own their own clinics, home health companies and hospice providers now, too. If hospice care is forced under Medicare Advantage, every dollar sent for end-of-life care could flow through entities the parent company controls – circumventing congressional medical loss ratio requirements while stuffing executives’ and shareholders’ billfolds.

(And not to mention: If Rep. Schweikert gets his way, independent hospice providers will probably be forced to sell themselves off to companies like UnitedHealth Group and CVSHealth as scrap metal.)

Terrible Legislation for a Terrible Program

I said this above: H.R. 3467 is terrible legislation. 

As written, the bill would make it harder for seniors to get the care they paid for all their working lives. It would end current and future seniors’ right to vote with their feet and choose the health coverage they want. It would be another massive handout to the big for-profit health insurance companies that already rake in billions of dollars through their private Medicare businesses.  

But thankfully, a wide swath of America is calling out the shortcomings of Medicare Advantage. 

In the last year, scrutiny by the U.S. Department of Justice on Medicare Advantage plans has intensified. This includes recent reports that the DOJ and the Health and Human Services Inspector General questioned former UnitedHealth Group employees about the company’s Medicare Advantage billing practices.

Yahoo News! reports that two Rhode Island lawmakers, State Sen. Linda Ujifusa and State Rep. Jennifer Stewart, are lobbying their federal counterparts to make reforms to private Medicare Advantage plans after negotiations between UnitedHealthcare and Brown University Health’s four Rhode Island hospitals failed, leaving patients in coverage limbo.

And in addition to the Feds and the states, advocates on the ground continue to press regulators and policymakers, too. A recent webinar hosted by the Labor Campaign for Single Payer titled “Medicare Advantage and the Privatization of Healthcare: What Unions Need to Know” featured legislators, consumer advocates and labor representatives. And last week, the Center for Health & Democracy (a non-profit that I run) sent a letter with 64 other organizations urging congressional leadership to rein in waste, fraud and abuse in Medicare Advantage.