Celebrating 400k+ Views
Monthly Archives: November 2025
Comprehensive Set of Bills Introduced to Take on Medicare Advantage
Representative Mark Pocan (D-WI) yesterday introduced eight bills aimed at strengthening traditional Medicare and reining in some of the worst practices in the privately-run Medicare Advantage business. For years, lawmakers have danced around the mounting evidence that private Medicare Advantage plans overbill taxpayers between $80 and $140 billion annually and quietly impose barriers to seniors’ care to boost profits.
Traditional Medicare remains one of the most successful public programs in American history. It was built around a simple promise: If your doctor says you need care, you get it. But as Medicare Advantage has grown, that promise has eroded for millions of people. MA plans are largely run by big insurance conglomerates – like UnitedHealthcare, Elevance and CVS/Aetna – and those insurers decide what care is covered, which doctors you can see and how long you can stay in a hospital. Each cent they have to shell out for your care is a cent they can’t keep in their pockets or split with their shareholders. Wall Street’s relentless demand for more and more of that money incentivizes them to deny or delay care that mean life-and-death for millions of American seniors.
And it’s not just health care policy nerds like me that have been focused on this issue – even the U.S. Department of Justice (DOJ) has taken aim at Medicare Advantage. In February, news broke that the DOJ had launched a civil fraud investigation into UnitedHealth Group, the largest MA insurer, for the company’s alleged use of diagnoses that trigger higher Medicare Advantage payments. And in July, the company confirmed it is the subject of a DOJ criminal investigation. The DOJ reportedly questioned former UnitedHealth Group employees about the company’s business practices.
You can see the entire package of bills on Pocan’s website. They include the Denials Don’t Pay Act, which would force Medicare Advantage plans to face real consequences if too many of their prior-authorization denials are overturned; The Right to Appeal Patient Insurance Denials (RAPID) Act, which would ensure every denial is automatically appealed, sparing sick and elderly patients from navigating a process many never even know exists; and the Protect Medicare Choice Act which would stop insurers and brokers from pushing seniors into Medicare Advantage by default.
Pocan and his co-sponsors understand that Medicare Advantage’s prior authorization hurdles and widespread denials are just Wall Street-directed obstacles that second-guess physicians and delay care. Patients pay the price. Doctors pay the price. And taxpayers pay the price.
A package like this was long overdue.
Thought of the Day
Thought of the Day
Your Health Insurance Premiums Are Going Up. Here’s Who’s Profiting.
More Perfect Union has just posted a video breaking down a truth that Big Insurance hopes you never hear: rising “health care costs” are really rising health insurance profits.
As I explained in the video, UnitedHealth, Cigna, CVS/Aetna are part of a cartel of corporate conglomerates that have built a business model that relies on overpayments in Medicare Advantage, shrinking doctor networks and a sprawling web of vertically integrated subsidiaries that vacuum up our premiums, deductibles and tax dollars — and turn them into shareholder returns as Wall Street relentlessly demands.
Here’s a bit of what I said:
“Your premiums, deductibles and pharmacy bills are all going up. We’re told it’s because medical costs are rising, but the bigger story is who’s capturing the money. In just three months, UnitedHealth Group made $4.3 billion in profits on revenues of $113 billion.
Over the past five years, the cost of a family premium has increased 26%. This year, the average cost of a family policy was almost $27,000.
Just about everybody with private insurance will be paying a lot more than that next year, regardless of whether you get it from your employer or buy it on your own. That’s because UnitedHealth and other big insurance companies cannot control rising health care costs.
In fact, insurance companies benefit from medical inflation. They just jack up their premiums enough to cover the additional cost and guarantee them a tidy profit.”
The video points out the real drivers of cost growth — from UnitedHealth’s nearly 2,700 acquisitions to Medicare Advantage overpayments that funnel billions from taxpayers into corporate profits.
If you haven’t watched it yet, I hope you will and share it with everybody else you know. It’s clear that Congress must pass common sense guardrails to stop Big Insurance from writing the rules of American health care and squeezing Americans.
Worker insurance cost to break $18,500
The average cost of covering a U.S. worker will exceed $18,500 next year, underscoring concerns about health care affordability and prompting benefit changes, according to a new Mercer survey.
Why it matters:
The added costs will force tough tradeoffs for employers who’ve tried to maintain generous benefits in tight labor markets and be passed on to workers already reeling from inflationary pressure.
- The corporations are likely to offer more plan options, take steps to guide workers to high-performing providers and provide specialized health programs in areas like diabetes and fertility.
By the numbers:
Higher drug spending, including on GLP-1 weight-loss medications, will drive up total health benefit costs an expected 6.7% in 2026, accounting for the highest increase in 15 years, Mercer said.
- The survey found that this year, the average cost of employer-sponsored coverage reached $17,496 per employee, a 6% increase that’s well above the rate of inflation and wage growth.
- A factor behind the increase was sharp growth in prescription drug spending, which rose 9.4% on average for large employers with 500 or more employees.
- 49% of large employers covered costly GLP-1 weight-loss drugs in 2025 — up from 44% in 2024.
What’s ahead:
Corporations already are increasing the number of medical plans to pick from.
- More are pushing plans with smaller networks of providers, along with stand-alone programs designed to help employees better manage specific health conditions, Mercer said.
Sanders pushes Senate Dems to go big on health care deal
Sen. Bernie Sanders (I-Vt.) is urging Senate Democrats to unite behind an expansive health care proposal in the party’s negotiations with Republicans to extend Affordable Care Act tax credits.
Why it matters:
GOP leaders have promised Democrats a vote on the expiring tax credits next month as part of their deal to end the government shutdown.
- Sanders wants the Democratic proposal to extend the ACA tax credits, repeal $1 trillion in GOP health care cuts, expand Medicare and lower prescription drug prices, he said in a letter to colleagues late Monday.
- Republicans, however, have signaled that any deal to extend the tax credits must be short term and require reforms.
- Premiums will more than double for millions of ACA enrollees next year if Congress does not renew enhanced marketplace subsidies by year’s end, according to a new analysis.
The big picture:
Democratic leaders have argued that the government shutdown has made health care a top political issue.
- Sanders, the top Democrat on the Senate Health, Education, Labor and Pensions Committee, said Democrats must make proposals that address “systemic deficiencies.”
- “We should not be defending a system which is not only, by far, the most expensive in the world, but one which numerous international studies describe as one of the worst,” Sanders wrote to Democratic senators.
Sanders’ HELP committee is expected to be involved in negotiations with Republicans over a potential bipartisan deal to extend the credits next month.
- A spokesperson for Senate Minority Leader Chuck Schumer (D-N.Y.) said: “The bill Democrats bring to the floor will be a caucus product.”
Between the lines:
Sanders acknowledged in his letter that his Medicare For All proposal “does not yet have majority support” in the caucus. But he said his latest proposal included “much-needed reforms.”
- Sanders also encouraged Democrats to propose investments to expand primary care services, ban stock buybacks and dividends and substantially reduce CEO compensation in the health care industry.
GOP doubles down on ACA subsidy alternatives
Republicans are taking a harder line against extending enhanced Affordable Care Act subsidies — and doubling down on an alternative plan that would send the money directly to consumers.
Why it matters:
President Trump’s opposition to an extension makes it increasingly unlikely that Republicans will agree to renew the tax credits, even though it’s not clear how the GOP alternative would work or whether the party can reach a consensus.
Driving the news:
Trump wrote on Truth Social on Tuesday that the “only” plan he will support is “sending the money directly back to the people,” and that Congress should not “waste your time” on anything else, like a subsidy extension.
- Trump didn’t elaborate on how his plan would work. The ACA already gives people financial help in buying insurance.
Some GOP proposals envision giving people money for a health savings account on top of existing ACA coverage, mitigating concerns about healthy people leaving the market.
- Senate health committee Chair Bill Cassidy (R-La.) outlined a plan on Monday that would redirect the enhanced subsidy money to an HSA to help pay out-of-pocket costs for people who chose bronze-level ACA plans, which tend to have high deductibles.
- He argued the move would direct money away from insurance companies and to consumers, and empower them to shop for health services.
Another possible outcome would be allowing people to buy cheaper, skimpier coverage that doesn’t comply with the ACA’s benefit requirements. Some policy experts warn that would destabilize the ACA markets, by prompting an exodus of healthier people.
- That would leave a sicker risk pool and prompt insurers to raise premiums, resulting in a “death spiral,” said Larry Levitt, executive vice president for health policy at KFF.
- By contrast, “I don’t think there’s any risk of, you know, a collapse or death spiral, from what Senator Cassidy is talking about,” Levitt said, though without the enhanced subsidies there would still be “potentially millions of people who just won’t be able to afford insurance at all.”
Between the lines:
Senate Majority Leader John Thune (R-S.D.) wouldn’t rule out a bipartisan solution when asked about Trump’s comments on Tuesday, saying “we’ll see” how negotiations go and that “there’s an openness” to a deal on the GOP side.
- He said the biggest obstacle, though, could be whether Democrats agree to apply the Hyde Amendment to the subsidies and add restrictions on using the funds for abortions.
The intrigue:
Cassidy is framing his plan as the most realistic option, given White House and House GOP leadership resistance to the subsidies.
- “The president is not going to sign a straightforward extension of premium tax credits,” Cassidy said. “So if you actually want something which can pass and get a vote on the House floor, then what the president is proposing is actually a better way.”
Yes, but:
Democrats believe mounting public concern about rising health costs gives them the upper hand pushing for a subsidy extension.
- “Sending people a few thousand dollars while doing nothing to lower health care costs is a scheme to help the ultra-wealthy at the expense of working people with cancer or pre-existing conditions,” Senate Democratic Leader Chuck Schumer said in response to Trump’s comments.
- “Americans want Congress to extend the ACA tax credits to keep health insurance premiums from skyrocketing on January 1,” he added.
The big picture:
The war of words is further diminishing the chances that a group of moderates in both parties can find a bipartisan agreement to extend the subsidies with some modifications favored by Republicans, like an income cap and anti-fraud measures.
- House GOP leaders have also been criticizing the subsidies. House Majority Leader Steve Scalise (R-La.) said on Fox News on Sunday that the party would be bringing forward legislation in the coming weeks on other ways to lower costs, like expanding HSAs or cracking down on pharmacy benefit managers.
- The Senate Finance Committee will hold a hearing Wednesday morning on health care costs, giving senators a chance to stake out their positions further in public.
The bottom line:
It’s unlikely that Trump’s plan would gain the necessary 60 Senate votes to advance. But it could give Republican senators political cover if they oppose a subsidy extension.
- Republicans could still opt to use the reconciliation process to pass a bill with a simple majority. Though the White House floated the idea on Tuesday, it’s not clear if any GOP-only plan has the votes to pass.
Sign of the Times
Thought of the Day
HENRY KOTULA 