Republicans Eye Medicare Advantage Rule Changes, But Maybe Not Just Yet
At a subcommittee hearing, lawmakers expressed a willingness to legislate prior authorization and "upcoding" practices used by insurers. It's not clear when they might take action in light of a packed health policy agenda in the wake of passing the One Big Beautiful Bill Act.
Modern Healthcare:
Medicare Advantage House Hearing Provokes Criticism Of Program
Republicans may be falling out of love with Medicare Advantage, a program the party has long championed. Medicare Advantage needs an overhaul and the health insurance companies that administer benefits for more than half of Medicare enrollees need to be reined in if the privatized system is to be preserved, GOP lawmakers said at a House hearing Tuesday. (McAuliff, 7/22)
More Medicare news —
Modern Healthcare:
UnitedHealthcare, Humana Rule Medicare Advantage Markets: Study
Medicare Advantage competition was meager in 97% of counties last year, where beneficiaries could choose among just a handful of dominant insurers. The health policy research institution KFF analyzed Centers for Medicare and Medicaid Services data on the plans available across the U.S. and Puerto Rico in 2024. The findings indicate that Medicare enrollees have few options in most areas. (Broderick, 7/22)
Modern Healthcare:
Physician Fee Schedule Proposal Hits Specialist Billing Codes
The Centers for Medicare and Medicaid Services has set in motion a quiet transformation in how Medicare pays doctors. Tucked inside the Medicare Physician Fee Schedule proposed rule for 2026 that the agency issued last Monday is a plan to move away from calculating rates using survey data from the Relative Value Scale Update Committee. (Early, 7/22)
On Medicaid cuts —
KFF Health News:
Republicans Call Medicaid Rife With Fraudsters. This Man Sees No Choice But To Break The Rules
As congressional Republicans finalized Medicaid work requirements in President Donald Trump’s budget bill, one man who relies on that government-subsidized health coverage was trying to coax his old car to start after an eight-hour shift making sandwiches. James asked that only his middle name be used to tell his story so that he wouldn’t lose health coverage or be accused of Medicaid fraud. He found his food service gig a few weeks into an addiction treatment program. The man in his late 30s said his boss “hasn’t been disappointed.” (Houghton, 7/23)
Stat:
Kentucky’s Rural Cancer Care, A National Model, Faces Medicaid Cuts
The giant inflatable colon loomed over the rural health clinic, pink undulations exclaiming its presence to all who passed by. Caught by a breeze, the intestine tugged at a metal handrail where Tonya Pauley had tied it down. Those curious enough to walk inside found information about the value of screening for colon cancer, which is more prevalent in Kentucky than any other state and often treatable if detected early. (Alcorn, 7/23)
Other health news from Capitol Hill —
Stat:
House Oversight Panel Scrutinizes Organ Transplant System
Members of a congressional oversight committee said Tuesday that they fear public trust in organ donation has been fractured after a federal report found that an organ procurement organization ignored signs of life in patients when authorizing attempted organ removals. (Cirruzzo, 7/22)
Military.Com:
Lawmaker Calls For Expanded Probe Of Cancer Concerns Among Nuclear Missile Troops
An amendment added to the House version of a must-pass national defense bill calls for more research and scrutiny into cancer concerns among troops who worked with America's nuclear missiles. A provision added by Rep. Don Bacon, R-Neb., in the House draft of the annual legislation seeks to review the occupational health and safety conditions of the facilities where troops oversee and work on the Minuteman III intercontinental ballistic missile. The issue hit close to home for the retired Air Force brigadier general and commander turned lawmaker. (Novelly, 7/22)
