Republicans’ health care proposal if Trump wins? More private Medicare

The television advertisements are displayed seniors playing tennis, golfing and riding motorcycles. In other cases, famous pitchers will know, such as an actor William Shatner, NFL star Joe Namat and former Republican governor of Arkansas Mike Huckabee – promising new benefits beyond photos of government-issued ID cards.

These are all ads for Medicare Advantage, and if Donald Trump wins the White House, Americans may see a lot more of them.

That’s because one of the only specific features of Republicans’ health care policy is further privatizing the program — selling more of the plans advertised in ads like this.

“We groan when we think of (Medicare) Advantage as insurance,” said Dr. Karen Kinsell, the only doctor in Fort Gaines, Georgia, a rural community where more than a third of the population lives below the poverty line.

Medicare Advantage is private insurance paid for by the federal government, a program approved in 1997 due to concerns about the cost of Medicare. Insurance companies promised cheaper plans with better benefits.

One of the key differences for patients is the imposition of “networks” in Medicare Advantage plans, or a limited number of doctors and hospitals that a patient can visit at a reduced rate. Traditional Medicare Does Not Cover Networks – 98% of providers participate in the US. However, traditional Medicare has monthly costs – most people pay $ standard rate from $174.70.

Medicare Advantage plans can be attractive because they often include food or transportation cards, $0 monthly premiums, and hearing, vision and dental benefits – none of which are included in traditional Medicare.

Kinsell notes that the problems usually start when people get sick.

“Patients couldn’t go to or stay in rehab,” she said. Others had to pay $50 a day for rehabilitation, when the service is normally free for a short period of time in traditional Medicare.

“We have spent a lot of time in our district office with seniors who have been duped by these corporate insurance plans,” said Democratic U.S. Rep. Pramila Jayapal of Washington state. Jayapal has called for “urgent reforms” and consumer protections to be added to Medicare Advantage.

“They adopted the name, so seniors actually think they’re signing up for Medicare,” she said.

Despite complaints from doctors and patients, fraud investigations, accusations insurers used artificial intelligence models to deny care to seniors, and a pile of evidence that Medicare Advantage costs taxpayers more, Republicans have continued to push the program. The most specific health care policy proposals are laid out in Project 2025, the Heritage Foundation’s conservative playbook.

Amid a tangle of complaints about vaccination mandates and no fewer than 199 mentions of abortion, the document also proposes further privatizing Medicare through Medicare Advantage.

Medicare Advantage “offers beneficiaries a wide range of competitive health plan choices – a richer set of benefits than traditional Medicare offers and at a reasonable price,” Project 2025 argues. Republicans should make this the default enrollment option and “remove burdensome policies that micro-manage plans,” the document said.

The document also proposes to “give beneficiaries direct control over how they spend Medicare dollars,” which Democrats say is a voucher programsomething Republican tried to push in the Trump administration.

“That’s basically been the playbook for Medicare privatization ever since these corporate Medicare ‘dis-Advantage’ plans – that’s what I call them – started,” Jayapal said. “It was their in-road.”

That, like many of Donald Trump’s proposals, will likely cost the federal government a lot of money.

“The federal government significantly overpays Medicare Advantage plans relative to what it spends on individual and traditional Medicare – without significant profits in return,” said David Lipschutz, co-director of the Center for Medicare Advocacy.

Research shows that Medicare Advantage plans are estimated to cost the federal government $83 billion more than traditional Medicare in 2024 without corresponding improvements in health, according to the congressionally appointed nonpartisan research firm Medicare Payment Advisory Council. Using standard registration could increase those costs to another $2 trillion over 10 years, according to left-wing movements Center for American Progress.

The interests for private health insurers are just as great. One of the largest Medicare Advantage providers, United Healthcare, earned 46% of its $281 billion in total revenue from Medicare Advantage enrollees, even though they represent only 15% of the company’s beneficiaries, an Accountable analysis shows. USA The analysis was shared exclusively with the Guardian.

“The fact that this is becoming something that conservatives are trying to promote as a one-size-fits-all model is alarming because it is a way to just increase profits for insurance companies,” said Tony Carrk, executive director of Accountable.US.

The problems with the program are so acute that at some point in 2022 eight of the ten largest insurance companies that sold Medicare Advantage plans were defendants in federal fraud or whistleblower cases.

“Part of the problem with having private plans in Medicare, or really any health care space, is the promise that they can provide better care more efficiently,” Lipschutz said. “And neither happened.”

While Republican hawks of old might balk at such costs, the proposal to further privatize Medicare is in line with a long-held Republican philosophy that has survived Trumpism: the government is inherently unreliable, and ordinary people need a financial reason to to do good.

“The problem with the left is that they don’t think in economic terms,” says John Goodman, an economist who has advised virtually every Republican presidential candidate on health since George W. Bush. He said he is currently working with the America First Policy Institute, a pro-Trump think tank.

Philosophically, Goodman believes that Americans need “economic incentives” to do the right thing.

For patients, such as someone with diabetes, that can mean cheap insulin (a carrot) and the specter of a high bill if you don’t get your diabetes under control and end up in the hospital (a stick). For doctors, it can mean jumping through bureaucratic hoops to get approval for a procedure, called prior authorization, to avoid waste.

Critics argue that debates about “economic incentives” mask what are in fact “catastrophic” health costs. Medicare Advantage plans may require patients to spend as much as $13,300 per year for out-of-network providers by 2024. More than a third of all Medicare Advantage enrollees live on less than $10,000 a year, according to the Commonwealth Fund. Nearly 95% of all seniors have a chronic condition, and more than 78% have two or more, according to the National Council on Aging.

Although Trump has rejected Project 2025, he maintains deep ties with its authors. The health care proposals were written by Roger Severino, his own former director of the Department of Health and Human Services’ Office of Civil Rights.

Notably, Goodman found Project 2025 a “bad document” whose many references to abortion would turn off voters. But he agrees with proposals on Medicare.

In the 2024 GOP PlatformTrump promised “not to cut a cent in Medicare,” but gave no further details. That’s consistent with the Project 2025 plan — which would require much more money to expand Medicare Advantage enrollment.

According to Goodman, there is at least one element of humor in this branch of health policy: the idea that the left would propose a health care system in which people do not have to pay for health care.

“In fact, the Bernie Sanders types don’t think economic incentives should play any role in health care,” Goodman said.