Congresswoman has previously called out how Medicare Advantage plans overcharge taxpayers and urged federal agencies to improve data collection

September 29, 2022 - WASHINGTON - Congresswoman Katie Porter on Wednesday introduced legislation to help patients and government watchdogs evaluate the quality of private health insurance plans provided through Medicare. The Medicare Advantage Consumer Protection and Transparency Act, co-led by Representatives Diana DeGette (D-CO), Lloyd Doggett (D-TX), and Jan Schakowsky (D-IL), improves data collection and holds insurers accountable for following the law.

“Insurers that provide older adults with subpar care should be held accountable—and we need to have the data to do it,” said Congresswoman Porter, a longtime consumer protection advocate. “The current system we have allows Medicare Advantage plans to escape scrutiny, depriving older Americans of the care they need and cheating taxpayers out of what we all pay for. Our Medicare Advantage Consumer Protection and Transparency Act will empower watchdogs and lawmakers to verify that Medicare Advantage is working as well as it should be.”

The Medicare Advantage Consumer Protection and Transparency Act requires insurers to provide information related to coverage, claims, and denials, which government agencies and the public would have access to. The bill also requires plans to provide consumers with clearer and more accurate descriptions of the services they offer, to protect patients from deceptive marketing practices. This bill follows a previous effort by Representatives Porter and DeGette to urge the Centers for Medicare and Medicaid Services to improve how the agency collects data from insurers.

“As more Americans enroll in Medicare Advantage plans, we need to make sure these plans are working for them,” said Congresswoman DeGette. “This legislation will improve the transparency of our Medicare program to make it easier for consumers to choose the plan that’s right for them. It will also hold these plans more accountable to ensure they are providing our seniors the coverage they deserve.”

“The promise of Medicare for American seniors and individuals with disabilities is for comprehensive, affordable, and quality health care—not for taxpayers to consistently pay more and more for less and less care,” said Congressman Doggett, Chair of the House Ways & Means Health Subcommittee. “The Medicare Advantage Consumer Protection and Transparency Act will provide important transparency to understand whether Medicare Advantage provides any advantage at all. Following alarming reports concerning high rates of denials of care, limited provider networks and inaccurate directories, and failure to report encounter data used to assess quality and frequency of care, better transparency is vital to protect taxpayer dollars and ensure beneficiaries are receiving comprehensive care. This legislation requires extensive data disclosure on supplemental benefit design, consumer cost-sharing expenditures, denials of care, and encounter data.”

“I am extremely concerned about Medicare Advantage plans that too often use deceitful practices. Seniors deserve quality, transparent health care,” said Congresswoman Schakowsky. “During a hearing in the House Energy and Commerce Subcommittee on Oversight & Investigations, we learned that Medicare Advantage (MA) plans have deceitfully made seniors seem sicker than they are so the plans can line their own pockets. These ‘upcoding’ practices accounted for $12 billion in additional payments to MA plans. Meanwhile, these same MA plans deny coverage and use delay tactics to prevent seniors from accessing much-needed care. I am proud to co-lead the Medicare Advantage Consumer Protection and Transparency Act. This bill will require MA plans disclose data showing how much care seniors are receiving and how often they are denied coverage. It will also require MA plans disclose information on their supplemental benefits. Seniors deserve better!”

The Medicare Advantage Consumer Protection and Transparency Act is endorsed by Public Citizen, the National Committee to Preserve Social Security and Medicare, Social Security Works, the Center for Medicare Advocacy, Just Care USA, and the Center for Health and Democracy.

“We applaud Congresswoman Porter for putting forward legislation to bring transparency to Medicare Advantage,” said Maya MacGuineas, President of the Committee for a Responsible Federal Budget. “With the Medicare trust fund just a few years from insolvency, this is an important step towards addressing Medicare Advantage overpayments. Almost half of all Medicare beneficiaries are enrolled in Medicare Advantage plans and it is essential that lawmakers know how taxpayer dollars are being spent by these private plans.”

Congresswoman Porter has consistently conducted oversight to verify that Medicare is working for patients and taxpayers. Earlier this year, she called out how Medicare Advantage insurers bill patients as sicker than they are to line their pockets with taxpayer dollars. Her proposal to hold Big Pharma accountable for unreasonable price hikes became law as part of the Inflation Reduction Act. She has also introduced bipartisan legislation to cap unfair late Medicare enrollment penalties levied on older adults and Americans with disabilities.
Source: Congresswoman Katie Porter