Groups representing insurers are pushing back on proposed tighter regulations on Medicare Advantage coding.
Senate Republicans are considering targeted changes to Medicare Advantage as part of the sweeping “One Big Beautiful Bill.” Lawmakers are considering adding provisions of the No UPCODE Act to the package.
The bipartisan proposal was first floated by Sens. Bill Cassidy, MD, and Jeff Merkley in 2023, and would make changes to the risk-adjustment model MA plans use to bill the federal government, and limit the ability to include old or unrelated medical conditions in the cost of care.
The proposal could generate more than $100 billion in savings, according to Politico. Lawmakers are considering the proposal as one way to offset the costs of the budget reconciliation bill. The Congressional Budget Office estimates the bill would add $2.4 trillion to the national debt over the next decade.
The 1,116-page legislation includes major changes to Medicaid and ACA coverage, and is projected to increase the number of uninsured Americans by around 11 million by 2034.
Groups representing insurers have said the No UPCODE proposals amount to a cut in funding for MA plans.
Mike Tuffin, CEO of AHIP, said lawmakers made “a clear promise” not to cut Medicare funds as part of budget reconciliation legislation.
“Last-minute attempts to cut Medicare Advantage to fund other priorities would directly undermine that promise and lead to higher costs and reductions in benefits for more than 34 million seniors and people living with disabilities,” Mr. Tuffin said in a June 9 statement. “We oppose cuts to Medicare Advantage, including the No UPCODE Act, and urge Congress to keep the promise to America’s seniors.”
Mary Beth Donahue, CEO of the insurer-backed Better Medicare Alliance, said cuts to Medicare Advantage would “break a promise to millions of seniors who rely on it.”
“American seniors are overwhelmingly satisfied with the coverage they choose through Medicare Advantage, which has far greater program integrity than fee-for-service Medicare,” Ms. Donahue said in a June 6 statement.
