Proposed changes to Medicare Advantage are unlikely to be included in a final budget deal, The Hill reported June 11.
Senators had floated adding provisions of the No UPCODE Act, which targets overpayments in the program, to the massive federal budget bill.
Sen. Kevin Cramer, R-N.D., who first raised the idea of targeting MA savings in the bill, told The Hill the final legislation is unlikely to touch Medicare.
The 1,100-page “One Big Beautiful Bill” includes cuts to Medicaid and the ACA, and is projected to increase the number of uninsured individuals by nearly 11 million by 2034, according to the Congressional Budget Office.
The package, which passed the House on May 22, is expected to add $2.4 trillion to the national debt over 10 years, according to the CBO. Lawmakers raised cracking down on MA spending as one way to offset the cost of the bill. The proposal could generate more than $100 billion in savings, according to Politico.
Mr. Cramer told The Hill there’s not “a stomach for” Medicare changes in the bill.
“I think that the president doesn’t want to touch Medicare,” he said.
Insurers opposed the No UPCODE Act, saying it would amount to a cut in funding for Medicare Advantage plans.
The No UPCODE Act, first introduced by Sens. Bill Cassidy, MD, R-La., and Jeff Merkley, D-Ore., in 2023, would change how risk adjustment payments MA insurers receive are calculated, including limiting the use of outdated or unrelated diagnoses when assessing costs.
Nearly every major Medicare Advantage insurer has been accused of, or settled allegations of upcoding — making patients appear sicker than they are in their medical records to receive higher reimbursements from the government.
The Medicare Payment and Advisory Commission estimates MA insurers will receive up to $40 billion in overpayments related to coding intensity in 2025.
Though the No UPCODE Act measures are unlikely to be included in budget reconciliation legislation, lawmakers could still consider the measure in the future, Politico reported June 10.
“There is a lot of work to be done to make sure you don’t have unintended consequences. But I think that is an area for longer-term gain,” Sen. Thom Tillis, R-N.C., told Politico.
