PNHP

Member Interest Groups (MIGs)

Welcome to the PNHP Member Interest Groups (MIGs) Hub.

While PNHP has traditionally organized through city- and state-based chapters, we’ve recently expanded to include specialty-focused Member Interest Groups (MIGs). These groups bring together members around specific medical specialties or social justice issues to deepen our advocacy and organizing efforts.

If you’re interested in joining one of our current MIGs—or starting a new one—you’re in the right place.

Learn more about our existing MIGs

Infectious Disease:

Pediatrics:

Psychiatry:

Reproductive Justice:

Start your own MIG

Don’t see your medical specialty or advocacy interests represented above? Email PNHP national organizer Rebecca Delay at rebecca@pnhp.org and we’ll help you connect with like-minded members!

The Medicare for All Act of 2025

On April 29, 2025, Rep. Pramila Jayapal, Rep. Debbie Dingell, and Sen. Bernie Sanders introduced the Medicare for All Act in the U.S. House (H.R. 3069) and U.S. Senate (S. 1506). These landmark pieces of legislation would finally establish a single-payer national health program in the United States.

PNHP welcomes these bills and urges Congress to move quickly to guarantee universal coverage, comprehensive benefits, and zero out-of-pocket costs for all U.S. residents.

Overview of the Medicare for All Act

Activism on the Medicare for All Act

  • Send an email to your legislators and and ask them to co-sponsor the bill.
  • Call your representative and senators at (202) 224-3121 and ask them to co-sponsor.
  • Schedule in-person meetings with your legislators—or with health policy staffers at their district offices; this is a crucial part of building powerful relationships with your representatives.
  • If your legislator is already a co-sponsor, thank them for their support and ask them to be even more public in their single-payer advocacy. See the Congressional website for a list of current co-sponsors in the House and Senate.
  • Seek out allied organizations, both locally and nationally, to expand the reach of your activism. Review this list of over 100 organizations that have endorsed Medicare for All.
  • Write an op-ed or letter to the editor supporting the Medicare for All Act.

Introductory press conference

Organizing for Medicare for All virtual rally

Social media graphics

Original posts on Instagram, Bluesky, and Facebook

Original posts on Instagram, Bluesky, and Facebook

Original posts on Instagram, Bluesky, and Facebook

Original posts on Instagram, Bluesky, and Facebook

Original posts on Instagram, Bluesky, and Facebook

Original posts on Instagram, Bluesky, and Facebook

PNHP Newsletter: Spring 2025

Table of contents

Click the links below to jump to different sections of the newsletter. To view a PDF version of the shorter print edition of the newsletter, click HERE.

If you wish to support PNHP’s outreach and education efforts with a financial contribution, click HERE.

If you have feedback about the newsletter, email info@pnhp.org.

PNHP News and Tools for Advocates

Save the Date for our Annual Meeting in Washington, D.C.

Data Update: Health Care Crisis by the Numbers

PNHP Chapter Reports

SNaHP Chapter Reports

Responding to the UnitedHealthcare CEO Murder

PNHP in the News

PNHP News and Tools for Advocates

Welcome letter from PNHP’s new president, Dr. Diljeet Singh

PNHP president Dr. Diljeet K. Singh

With appalling health outcomes, deplorable health inequities, and staggering rates of medical bankruptcy, we have long known American health care has been broken by an unregulated, profit-driven health insurance industry that must be dismantled. Since taking office, the Trump administration has taken us in the opposite direction. They have begun the destruction of our medical research and public health infrastructure while simultaneously threatening the foundations of traditional Medicare and Medicaid.

At PNHP, we know the fight for health justice is a long one—but we take strength from our growing coalition, and from members like you, who continue to speak out and organize for a truly equitable health care system. We have hope and deep gratitude for all our members engaged with the movement and working to support the well-being of all.

We are especially proud to congratulate our graduating SNaHP (soon to be PNHP!) members who have matched in various specialties across the country. In them, we see the future of our profession: bold, principled, and committed to transforming the system. We are grateful for their co-leadership in our organizing efforts and are excited to support them through their residencies and fellowships.

As we continue building power within our movement, we want to share a few highlights from what we’ve been working on this year: Our Moral Injury Project continues to shine a light on how profit-driven “care” harms both patients and health professionals, our Equity Project is exploring how privatized Medicare plans exacerbate racial inequities, and our legislative advocacy has been in full force, with PNHP members organizing 45 legislative visits, calling for action against corporate abuse, overpayments, and care denials.

Our work does not happen in isolation—we are constantly collaborating with allied organizations to build collective power and push for systemic change. One powerful example was the recent Dr. Oz “shadow hearing,” which we co-hosted with Social Security Works and which was co-sponsored by 12 other organizations. This event spotlighted the devastating harms of corporate health care and amplified the voices of patients, providers, and advocates demanding a better system.

Working together makes us stronger—and brings us closer to the just and equitable health care system we all deserve. That spirit of collaboration and collective action will be front and center at PNHP’s Annual Meeting in Washington, D.C. on Nov. 1-3. We’ll dig deeper into our campaigns to challenge Medicare privatization and strategize together on how to grow our movement in the year ahead.

Thank you so much for your membership, your engagement, and your strength during these politically turbulent times. We are proud to be in this movement with you. Please reach out if I can help support you in any way.

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“Shadow Hearing” for Dr. Mehmet Oz

On Friday, March 14, at 9:00 a.m. Eastern—one hour before Mehmet Oz’s official hearing in Washington, D.C.—PNHP hosted a virtual “shadow hearing” to expose the truth about his plans for CMS: Medicaid cuts, Medicare privatization, and the devastating consequences of Medicare Advantage (MA). This event, which was co-sponsored by 13 allied health justice organizations, featured 11 speakers who shared firsthand experiences of the harm caused by privatized health care, whether as patients struggling to access care or as providers fighting insurance denials.

Social Security Works executive director Alex Lawson and PNHP board member Dr. Alankrita Olson joined us live from outside the hearing room in D.C., offering real-time updates on the scene. Together, we worked to counter the pro-privatization narrative pushed by Dr. Oz, whose self-serving perspective disregards the health and well-being of the American people.

The speakers underscored the dangerous reality of so-called “Advantage” plans, which systematically deny care to boost corporate profits, leaving patients in medical and financial distress. Stories highlighted insurers’ routine delays and denials, the administrative burdens placed on providers, and the real-life consequences for those trapped in a system designed to prioritize profits over patients.

This event served as a direct call to action, urging Americans to contact their legislators and demand that they reject policies that would further entrench the privatization of our public health programs.

To learn more about actions you can take today, visit pnhp.org/Oz.

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PNHP’s Moral Injury Project receives IRB approval

The PNHP Moral Injury Project has officially received Institutional Review Board (IRB) approval, and we are moving forward with full-scale research and outreach efforts! Since January 2025, our working group of 25 PNHP members and SNaHP students has been meeting regularly, organizing into four dedicated teams to advance different aspects of the project.

The Presentations Team is focused on developing and delivering presentations on moral injury at PNHP chapter meetings, medical society events, and residency programs to raise awareness and spark discussion. The Materials Team is creating essential outreach materials, including an FAQ sheet, flyers, an information sheet, and an outreach toolkit, equipping members with the necessary resources to educate and engage others. (All of these materials can be found at pnhp.org/MoralInjury.) The Research Team is exploring nontraditional research strategies, such as social media outreach, to expand the project’s visibility and impact. Finally, the Network Outreach Team is working to establish connections with medical societies and residency programs to distribute our survey and link the Presentations Team with opportunities to present.

We are also advancing into the second phase of our interviews, where we are designing guides and structuring physician interviews to gather firsthand accounts of moral injury in U.S. health care. Our first round of physician interviews are anticipated to be conducted by the end of April 2025.

If you would like to be involved in our Moral Injury Working Group, please contact Rebecca Delay at rebecca@pnhp.org. Stay tuned for further updates as we expand our outreach, research, and advocacy efforts!

PNHP’s Moral Injury Project is funded with generous support from the Robert Wood Johnson Foundation.

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Medicare “Advantage” report to measure racial inequities in MA

PNHP’s Medicare Advantage Equity Project is well underway, focusing on developing a comprehensive report analyzing the impact of MA on racial health inequities. This project seeks to examine and debunk insurers’ claims that their privatized Medicare plans promote health equity, equipping legislators with the information to challenge misleading narratives used to justify MA’s expansion. This project will strengthen PNHP’s advocacy by ensuring policymakers have access to credible research and critical stakeholder insights that expose the harm that corporate insurers inflict on marginalized communities.

To guide this project, we have established two advisory bodies. An internal advisory committee of eight PNHP and SNaHP members is helping shape the research process and ensure validity in our analysis. Additionally, an external steering committee of seven health equity experts from various organizations is advising on research practices, guiding our focus areas, and structuring a framework to align with the project’s mission. Their expertise ensures that our research remains thorough, relevant, and impactful.

So far, we have conducted a literature review exploring existing research on health outcomes for marginalized communities with heavy enrollment in MA plans. This review has helped us identify gaps in current research and begin structuring the framework for our report and the next phase of research. Moving forward, we are working to build upon these findings to present a clear, evidence-based critique of insurers’ equity claims while developing accessible materials for legislators and policymakers. As we continue, our goal remains clear: to expose how MA exacerbates racial health inequities and provide lawmakers with the resources needed to push back against privatization efforts that disproportionately harm vulnerable communities.

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Bringing our fight to Washington

Rep. Pramila Jayapal meets with PNHP and SNaHP members at our Annual Meeting in Chicago on Nov. 16, 2024.

On March 27, Rep. Pramila Jayapal sent a letter to the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), urging them to take action to curb waste, abuse, and patient harm in Medicare Advantage (MA).

The letter calls for eliminating waste and abuse by improving risk adjustment calculations in the proposed 2026 Medicare Advantage Rate Notice, strictly enforcing overpayment regulations outlined in the 2025 Medicare Physician Fee Schedule rule, and strengthening enforcement against MA insurers that illegally deny care.The letter also calls for reforms to promote health equity by addressing disparities in care outcomes and improving data-sharing mechanisms to help enrollees make informed choices.

PNHP has been actively engaging legislators on this issue, having conducted 45 legislative visits to urge lawmakers to sign onto this letter. Our efforts built on last year’s success, when PNHP’s advocacy helped CMS stand firm against aggressive industry opposition to a more reasonable 2024 MA rate hike. By mobilizing our network to support actuarially sound rate adjustments, we helped counter the immense lobbying power of corporate insurers.

While the political landscape may be more challenging in 2025, PNHP’s advocacy has proven highly effective, and continued mobilization is essential to holding CMS and HHS accountable.  Our members are off to an impressive start this year; Rep. Jayapal’s pro-Medicare letter was signed by 78 members of the U.S. House of Representatives, compared to 65 who signed a similar letter in 2024.

Looking ahead, we are anticipating the introduction of the Medicare for All Act in April. Reps. Jayapal and Dingell will be sponsoring the House bill while Sen. Bernie Sanders sponsors the Senate bill. As with previous versions, this legislation would establish a single-payer national health program, removing the profit-driven middlemen that exploit both patients and providers.

PNHP and our allies are already working to urge legislators to sign on as co-sponsors once the bill is introduced. We encourage all PNHP members and supporters to join this effort by contacting their legislators after the bill’s launch and either thanking them for co-sponsoring or urging them to get on board. As we continue to expose the failures of privatized health care and fight back against industry influence, Medicare for All remains the ultimate solution to our nation’s health care crisis. Our advocacy has already made a significant impact, and with strong grassroots mobilization, we can continue to push for fundamental reform.

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Save the Date for our Annual Meeting in Washington, D.C.

PNHP’s 2025 Annual Meeting is set for November 1-3 in Washington, D.C., bringing together physicians, medical students, and health care advocates for a powerful weekend of education and action! The weekend will kick off with the SNaHP Summit on Saturday morning, providing medical students with a dedicated space to strategize, connect, and strengthen their organizing efforts.

The PNHP Annual Meeting will begin Saturday afternoon and continue through Monday, featuring panels, discussions, and opportunities to deepen our advocacy for single-payer health care. The event will culminate in a Lobby Day and Rally at the Capitol on Monday, November 3, where members will demand action to protect and expand Medicare while pushing for a single-payer system.

Stay tuned for more details on programming, speakers, and registration!

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Data Update: Health Care Crisis by the Numbers

Corporate Profiteering

OIG: Insurers Should Pay Feds Millions: A new watchdog audit found that Humana and CVS Medicare Advantage plans owe the federal government $11 million in overpayments. The HHS Office of the Inspector General (OIG) audited medical claims from 2017-2018 and determined that 202 out of 240 reviewed diagnostic codes from Humana were unsupported by medical records, leading to an estimated $6.8 million in overpayments. Similarly, HealthAssurance Pennsylvania, a CVS subsidiary, had 222 out of 269 diagnostic codes lacking proper documentation, resulting in $657,744 in overpayments. The audit will be sent to CMS officials, who will decide whether to recoup the overpayments. The findings highlight ongoing scrutiny of Medicare Advantage plans and concerns that private insurers are overpaid by CMS. “Feds seek $11M refund from Humana, CVS,” Politico, September 26, 2024.

Report Reveals Billions in Excess Medicare Payments: A new inspector general’s report found that private Medicare insurers received approximately $4.2 billion in extra federal payments in 2023 for diagnoses obtained through company-initiated home visits—many of which did not lead to treatment. These diagnoses, including potentially inaccurate ones, triggered higher payments because Medicare Advantage insurers receive increased reimbursements when patients are classified with costly conditions. The findings raise concerns about how home visits are used to inflate payments without providing meaningful medical care. “Medicare Paid Insurers Billions for Questionable Home Diagnoses, Watchdog Finds,” The Wall Street Journal, October 24, 2024.

Medicare Advantage Denied 1.5 Million Claims in a Single Year, Leaving Patients Vulnerable: In 2019 alone, Medicare Advantage insurers denied 1.5 million claims—18% of all payments—even when they met Medicare coverage rules. These denials force enrollees to either forgo needed medical care or pay out-of-pocket. In 2024, the government will give private insurers an additional $64 billion to cover “free” benefits like dental and vision, yet insurers refuse to disclose how much they actually spend on patient care. A study found that only 11% of enrollees used dental benefits, while another found that a quarter never used any of the advertised perks. Meanwhile, major hospitals like Scripps Health and Mayo Clinic are rejecting Medicare Advantage patients due to unpaid bills. “The Medicare Advantage Trap: What They Don’t Tell You,” The Hartmann Report, October 5, 2024.

Private Medicare Plans Collected $7.5 Billion in Questionable Payments: A new report from the HHS Office of Inspector General (OIG) reveals that private Medicare Advantage plans received $7.5 billion in enhanced payments in 2023 based on potentially suspect patient diagnoses. Most of these risk-adjusted payments came from in-home “health risk assessments” and chart reviews—evaluations often conducted by individuals with no direct involvement in a patient’s care. UnitedHealth Group alone collected over $3.7 billion from these assessments, while Humana received nearly $1.71 billion and Cigna Group took in $237 million. The OIG is calling for greater oversight of these practices to ensure Medicare Advantage insurers are not inflating payments without providing necessary follow-up care. “Watchdog Flags $7.5 Billion Paid to Private Medicare Plans,” Bloomberg Law, October 24, 2024.

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Barriers to Care

80% of Mental Health Providers in Medicare Advantage Directories Are Unreachable: A Senate Finance Committee investigation found that Medicare Advantage (MA) plan directories are riddled with “ghost networks,” where listed mental health providers are often inaccurate, unavailable, or out-of-network. In a secret shopper study across six states, staff contacted 120 listed providers and found that 33% had incorrect or non-working numbers, while appointments could only be scheduled 18% of the time. In some states, the success rate was as low as 0%. The report highlights the serious barriers individuals face when seeking mental health care and calls on CMS to strengthen oversight of MA provider directories. It also urges Congress to mandate stricter accuracy requirements, transparency measures, and financial penalties for non-compliance. “Majority Study Findings: Medicare Advantage Plan Directories Haunted by Ghost Networks,” Senate Finance Committee, May 3, 2023.

Medicare Advantage Insurers Deny Critical Post-Acute Care at Alarming Rates: A U.S. Senate investigation found that UnitedHealthcare, Humana, and CVS—covering nearly 60% of Medicare Advantage enrollees—used prior authorization to deny critical post-acute care at disproportionately high rates. In 2022, UnitedHealthcare and CVS denied prior authorization for post-acute care at three times their overall denial rates, while Humana’s denial rate for such care was 16 times higher than its overall rate. UnitedHealthcare’s denials for skilled nursing facilities surged ninefold between 2019 and 2022, while CVS “saved” over $660 million in a single year by denying inpatient care requests. Internal documents show insurers used automation and predictive algorithms to increase denial rates, prioritizing financial savings over medical necessity. “Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care,” U.S. Senate Permanent Subcommittee on Investigations, October 17, 2024.

Prior Authorization Delays Linked to Severe Patient Harm, Physicians Report: A 2024 AMA survey found that 29% of physicians reported prior authorization (PA) has led to a serious adverse event for a patient in their care. Additionally, 23% said PA resulted in a patient’s hospitalization, 18% reported it caused a life-threatening event or required intervention to prevent permanent harm, and 8% stated that PA led to disability, permanent bodily damage, congenital anomalies, or even death. The findings highlight the significant risks PA policies pose to patient safety and the urgent need for reform. “2024 AMA Prior Authorization Physician Survey,” AMA, June 18, 2024.

Medicare Advantage Delays and Denials Worsen Rural Health Care Challenges: A report from the American Hospital Association found that 81% of rural clinicians say insurer requirements under Medicare Advantage (MA) reduce the quality of care, while MA patients experience 9.6% longer hospital stays before receiving post-acute care compared to traditional Medicare patients. Administrative burdens have also intensified, with nearly 80% of rural clinicians reporting increased paperwork over the past five years, and 86% stating that these challenges negatively affect patient outcomes. Delayed or denied MA payments further strain rural hospitals’ finances, threatening access to care in underserved areas. “The Growing Impact of Medicare Advantage on Rural Hospitals Across America,” American Hospital Association, February 2025.

Private Insurance and Medicare Advantage Have Higher Claim Denial Rates Than Traditional Medicare: An analysis found that 21% of people with employer-sponsored insurance and 20% of those with marketplace insurance experienced denied claims, compared to 10% of Medicare beneficiaries and 12% of Medicaid enrollees. A separate 2024 survey of hospitals and post-acute care providers by Premier, Inc. found that nearly 15% of medical claims submitted to private insurers were initially denied, with Medicare Advantage having a higher denial rate of 15.7%. “Breaking Down Claim Denial Rates by Healthcare Payer,” TechTarget, January 9, 2025.

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Pharma

Eli Lilly CEO Took Home $114 Million in 2024 Amid Record Profits and Perks: Eli Lilly CEO Dave Ricks made $114 million last year, a rare nine-figure payout for a health care executive, according to a new proxy statement. The company also reimbursed Ricks and two other executives for $186,000 in expenses related to a “global executive leadership meeting” held in Paris alongside the 2024 Olympics. Lilly’s soaring profits—$10.6 billion in 2024, more than double the previous year—were driven by its blockbuster GLP-1 drugs, Mounjaro and Zepbound. With investor enthusiasm for next-generation treatments, Lilly has become the world’s wealthiest health care company. “Lilly CEO Got a Big Payday (and an Olympics Treat),” STAT, March 12, 2025.

Pharmaceutical Companies Have Already Raised Prices on Over 800 Drugs in 2025: Drugmakers have increased the prices of more than 800 brand-name prescription drugs this year, with a median hike of 4%. Leadiant Pharmaceuticals raised prices significantly: by 15% to $149 per pill for Matulane, a Hodgkin disease treatment, and by 20% (to $2,597) for Cystaran, eye drops for cystinosis. The total number of price hikes has risen sharply from 140 announced in late December, with more expected by the end of 2025. “Big Pharma Has Already Raised the Prices of Hundreds of Drugs This Year,” Quartz, January 28, 2025.

Nearly 72 Million Americans Skipped Needed Care Due to Cost in 2024: The West Health-Gallup 2024 Survey on Aging in America found that an estimated 72.2 million adults—nearly one in three—did not seek necessary health care in the past three months (May-July 2024) due to cost, including 8.1 million Americans aged 65 and older. Additionally, nearly one-third (31%) of respondents expressed concern about affording prescription drugs in the next 12 months, a sharp rise from 25% in 2022. The findings highlight a worsening affordability crisis in the U.S. health care system. “Americans’ Ability to Afford Healthcare Hits New Low in 2024,” News Medical Life Sciences, July 17, 2024.

Majority of Congress Receives Significant Contributions from Pharmaceutical Industry: An analysis of OpenSecrets data found that most U.S. lawmakers receive substantial financial contributions from pharmaceutical and health product companies. On average, House Republicans received $45,000 and House Democrats $47,000, while Senate Republicans averaged $50,000 and Senate Democrats $69,000 in the 2024 election cycle. At least 72 of 100 U.S. senators received at least $10,000 from pharmaceutical PACs or employees, with 12 senators surpassing $100,000—including seven Democrats and five Republicans. The findings highlight the deep financial ties between lawmakers and the pharmaceutical industry. “How Many Members of Congress Receive Money from Pharmaceutical Company PACs?” DeseretNews, January 31, 2025.

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Health Inequities

Medicare Advantage Networks Restrict Access to Racially Concordant Physicians: A Health Affairs report found that Medicare Advantage (MA) network limitations exacerbate racial and ethnic disparities by restricting access to Black and Hispanic physicians, who are known to improve preventive care use among these populations. Black and Hispanic physicians are underrepresented in MA networks compared to White physicians (43.2% and 44.0% vs. 51.1%), and many Black and Hispanic beneficiaries lack any in-network doctors of their race. In 41.3% of counties, there are no Black physicians in MA networks, while 47.2% of counties lack Hispanic physicians. These restrictions limit culturally competent care, reinforcing barriers to preventive services and worsening health disparities for MA enrollees. “Medicare Advantage Networks Include Few Black or Hispanic Physicians, Making Concordant Care Inaccessible for Many,” Health Affairs, January 2025.

MA Enrollees Report Widespread Unfair Treatment in Health Care: A Health Affairs study of 1,863 Medicare Advantage (MA) enrollees from 21 plans found that 9% reported experiencing unfair treatment in a health care setting, with the most common reasons being health condition (6%), disability (3%), and age (2%). Among those reporting unfair treatment, 40% cited multiple forms of discrimination. Enrollees qualifying for Medicare via disability were more likely to report unfair treatment based on disability, age, income, race and ethnicity, sex, sexual orientation, and gender identity. “Medicare Advantage Enrollees’ Reports of Unfair Treatment During Health Care Encounters,” Health Affairs, May 29, 2024.

Fewer High-Quality Medicare Advantage Plans Available in Socially Vulnerable Areas: A study found that markets with greater unmet social needs—measured by higher Social Vulnerability Index (SVI) scores—have fewer high-quality Medicare Advantage (MA) plans. The most vulnerable markets had 1.5 fewer MA plans overall and 1.1 fewer plans rated 4 stars or higher compared to the least vulnerable markets. This disparity was most pronounced in the southern U.S., where a higher proportion of Black/African American populations reside. “Association of Social Vulnerability and Access to Higher Quality Medicare Advantage Plans,” Journal of General Internal Medicine, December 20, 2024.

Medicare Advantage Enrollment Growth Among Racial Minorities Driven by Financial Barriers, Not Equity: While industry apologists point to the increasing enrollment of racial and ethnic minorities in Medicare Advantage (MA) as a sign of greater equity, research suggests this trend is largely driven by financial necessity rather than improved access to quality care. A study in The American Journal of Managed Care found that 40% of Black and Hispanic Medicare beneficiaries are near-poor, earning between 101% and 250% of the federal poverty level (FPL). These individuals do not qualify for Medicare supplemental insurance but often struggle to afford necessary care. Compared to White beneficiaries, Black and Hispanic enrollees are less likely to have savings or supplemental coverage, making MA’s lower cost-sharing and additional benefits an economic relief rather than a fundamental improvement in care access. “Racial/Ethnic Disparities in Cost-Related Barriers to Care Among Near-Poor Beneficiaries in Medicare Advantage vs Traditional Medicare,” The American Journal of Managed Care, October 23, 2024. 

Medicare Advantage Attracts Low-Income Enrollees with Limited Benefits While Restricting Care: Claims that Medicare Advantage (MA) improves equity obscure the reality that many low-income beneficiaries choose these plans out of financial necessity rather than for superior care. A JAMA Health Forum study found that Black beneficiaries were 9.0 percentage points more likely to enroll in a plan with any dental benefit and 11.2 percentage points more likely to choose a comprehensive dental plan than White beneficiaries. However, this trend reflects cost-driven decision-making rather than expanded access to quality care. MA plans use zero-premium options and supplemental benefits to attract enrollees while simultaneously restricting provider networks and specialized care, ultimately reinforcing disparities rather than addressing them. “Enrollment Patterns of Medicare Advantage Beneficiaries by Dental, Vision, and Hearing Benefits,” JAMA Health Forum, January 12, 2024.

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Burnout

Medicare Advantage Prior Authorization Delays Harm Patients, Fuel Burnout: A 2024 AMA survey found that over 90% of physicians, including those treating nursing home patients, reported that prior authorization (PA) delays have caused significant patient harm. For 24% of these doctors, the delays resulted in hospitalization, permanent disability, or death. Physicians spend an average of 12 hours per week handling 43 PA requests, contributing to widespread burnout; 95% cite PA as a reason for stress, and one in five are considering leaving medicine within two years. “‘Broken System’ of Medicare Advantage Prior Authorizations Leads to Nursing Home, Hospital Woes,” Skilled Nursing News, October 29, 2024.

Physician Burnout Continues to Drive Early Retirements and Exits in 2024: A MGMA Stat poll found that 27% of medical groups had a physician leave or retire early in 2024 due to burnout, while 41% reported that burnout worsened this year. Meanwhile, 45% said burnout levels remained the same as last year. The poll, based on 449 responses, highlights the persistent impact of burnout on the health care workforce, even as unexpected turnover stabilizes. “Physician Burnout Still a Major Factor Even as Unexpected Turnover Eases,” MGMA, September 4, 2024.

Higher Nurse Turnover Intentions Linked to Increased Patient Mortality: A multinational study analyzing data from 1,046 nurses across 15 public hospitals in Italy found a direct correlation between nurse intentions to quit and patient mortality. The study focused on surgical patients aged 50 and older who had hospital stays of at least two days. Researchers found that for every 10% increase in nurses intending to leave their jobs, inpatient hospital mortality rose by 14%. “Study Links Nurse Intention to Quit with Patient Mortality,” Health Policy, March 16, 2024.

Emergency Medicine Tops List of Most Burned-Out Specialties in 2024: A Healthgrades survey of 9,226 physicians across 26 specialties found that emergency medicine had the highest burnout rate at 63%, followed by obstetrics/gynecology (53%), oncology (53%), and pediatrics (51%). 42% of physicians said they had been burned out for over two years, and 16% considered leaving medicine due to burnout. Key contributors included excessive bureaucratic tasks, long work hours, lack of respect from colleagues, and inadequate compensation. “2024’s Most and Least Burned Out Physicians by Specialty,” Healthgrades, April 16, 2024.

Nearly Half of Physicians Report Burnout, While Depression Rates Remain Stagnant: A Medscape survey found that 47% of physicians are currently experiencing burnout, while 24% report depression—a rate that has remained unchanged since 2020. The findings reveal ongoing challenges in physician mental health, underscoring the need for workplace reforms and support systems. “‘If Boundaries Are Set, It Is Possible’: Medscape Physician Mental Health & Well-Being Report 2025,” Medscape, January 31, 2025.

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Corporate Health Insurance

Humana Faces Billions in Losses After Medicare Advantage Ratings Drop: Humana, one of the largest Medicare Advantage providers, saw its stock plunge to a 15-year low after the federal government downgraded the rating for one of its major plans. In a filing to the SEC, Humana disclosed that only 1.6 million members—about 25% of its total—will be enrolled in Medicare Advantage plans rated four stars or higher in 2025, a sharp drop from 94% this year. CMS assigns star ratings based on factors like provider performance and plan administration, with higher ratings leading to lucrative government bonuses. A key Humana plan covering 45% of its Medicare Advantage members is expected to drop from 4.5 to 3.5 stars, potentially costing the company nearly $3 billion in 2026 bonus payments. Humana is appealing the rating but acknowledged its impact on future earnings. “Medicare Advantage Giant Humana Reels After Ratings Cut,” The Washington Post, October 2 2024.

UnitedHealth Faces Stock Decline Amid Medicare Billing Investigation and Industry Scrutiny: UnitedHealth’s Medicare Advantage division, the largest in the country with over 7.8 million enrollees, is under investigation by the U.S. Department of Justice for potential civil fraud related to its Medicare billing practices. When this story broke, it sent UnitedHealth’s stock plummeting more than 10% in pre-market trading, dropping over $52 to below $447 per share. Other Medicare Advantage insurers, including Humana, also saw stock declines. The company has faced mounting challenges, including increased health care usage, rate cuts, and a difficult period following the December shooting death of CEO Brian Thompson, which led to a sharp $100 drop in stock value. “UnitedHealth Stock Plummets Following US Medicare Billing Investigation Report,” CloudBrain, February 21, 2025.

Dr. Oz Tapped to Lead Medicare Despite Millions in Health Care Investments: President Trump’s pick to oversee the Centers for Medicare and Medicaid Services (CMS), Dr. Mehmet Oz, has reported owning up to $600,000 in stock from companies benefiting from private Medicare contracts. In 2022, Oz and his wife held at least $8.5 million in health care investments, including up to $550,000 in UnitedHealth Group stock and as much as $50,000 in CVS Health shares—both major Medicare Advantage insurers. As a Senate candidate, Oz promoted a “Medicare Advantage for All” plan, which would expand the privately run Medicare option despite research showing it costs taxpayers 22% more than traditional Medicare. “Dr. Oz is Trump’s Pick to Oversee Medicare. He Owns Healthcare Stocks That Could Benefit,” Quartz, November 20, 2024.

UnitedHealth Pushed Doctors to Inflate Diagnoses for Medicare Advantage Payments: Internal documents obtained by STAT News reveal that UnitedHealth pressured its physicians to add lucrative diagnoses to Medicare Advantage patients, boosting the company’s risk-adjusted payments by billions. A doctor leaderboard and $10,000 bonuses incentivized coding strategies that sometimes included clinically insignificant, marginally treatable, or even nonexistent conditions. The investigation exposes how UnitedHealth manipulated the payment system to maximize profits at Medicare’s expense. “Inside UnitedHealth’s Strategy to Pressure Physicians: $10,000 Bonuses and a Doctor Leaderboard,” STAT News, October 16, 2024.

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PNHP Chapter Reports

Arizona

The Arizona chapter held two legislative meetings with staff from Sen. Gallego and Rep. Ciscomani’s offices to discuss Medicaid cuts, Medicare Advantage, threats to the ACA, and global issues such as reductions to U.S. aid. Medicare Advantage was a central focus in both discussions. Chapter leaders have also been encouraging members to complete the moral injury survey.

To get involved in Arizona, contact Dr. Eve Shapiro at shapiroe@u.arizona.edu.

California

The Bay Area chapter has remained connected through ongoing monthly meetings, where members have engaged in discussions on health care issues, including the mental health crisis and the harms of privatization. One notable highlight was the publication of “My Brother’s Keeper: The Untold Stories Behind the Business of Mental Health—and How to Stop the Abandonment of the Mentally Ill” by psychiatrist Nick Rosenlicht in October, which sparked thoughtful conversation within the group.

To get involved in the Bay Area, contact Dr. Henry Abrons at habrons@gmail.com.

The Humboldt County chapter has been highly active throughout the year, engaging in local, state, and national advocacy. Highlights include hosting Assembly candidate Chris Rogers at a chapter meeting, launching a “stealth advocacy” program to counter local Medicare Advantage promotion, and raising significant funds at the North Country Fair booth. Members also participated in Pastels on the Plaza to promote single payer and engaged in media outreach through ads, op-eds, and radio interviews. Chapter leaders attended the PNHP Annual Meeting in Chicago, contributed to the Office of Health Care Affordability (OCHA) educational forum, and are working closely with the Movement to End the Privatization of Medicare. The chapter also endorsed the National Single Payer Day of Action on May 15 and remains deeply involved in advocacy against Medicare privatization.

To get involved in Humboldt County, contact Dr. Corinne Frugoni or Patty Harvey at healthcareforallhumboldt@gmail.com.

The Los Angeles chapter initially held hybrid monthly meetings at the Santa Monica Library, but due to low attendance, they have transitioned to more accessible Zoom meetings on the fourth Saturday morning of each month. These gatherings feature lectures and discussions on key health care topics, offering members a space to stay informed and engaged.

To get involved in Los Angeles, contact Dr. Nancy Niparko, nniparko@gmail.com, or Dr. Maleah Grover, mgm1payer@gmail.com.

A chapter member in Santa Barbara recently participated in a delegation to Cuba to observe their healthc are system and later presented a health policy seminar to share key takeaways. The chapter is also planning a legislative visit with their U.S. Representative on March 20 to discuss the harms of Medicare Advantage and to encourage support for Rep. Jayapal’s letter to CMS. Additionally, on April 1, the chapter will visit a local high school with two pre-med students to discuss the importance of single-payer health care.

To get involved in Santa Barbara, contact Dr. Nancy Greep at ncgreep@gmail.com.

Colorado

On February 27, the Colorado chapter hosted a powerful webinar titled “Denied,” featuring real-life experiences from U.S. and Canadian doctors and medical office staff. The panel highlighted the stark contrast between the two health care systems, particularly the ease of access and administration in Canada. The chapter continues to hold monthly joint meetings with PNHP members and Medical Professionals for Universal Healthcare, fostering collaboration and strategy-sharing. Recent recruitment efforts have resulted in 40 members signing up with expiration dates in 2026. Advocacy efforts have included outreach to four congressional offices, including Reps. Jeff Hurd and Jason Crow. The chapter also contacted Sens. Michael Bennet and John Hickenlooper, urging them to vote against the nominations of RFK Jr. and Dr. Mehmet Oz, and reached out to Rep. Diana DeGette to ask her to oppose Dr. Oz and support Rep. Jayapal’s letter to rein in Medicare Advantage overpayments and deceptive recruitment tactics.

To get involved in Colorado, contact Dr. Leslie Reitman at Les.reitman@gmail.com.

Georgia

Members of PNHP Georgia participate in a candlelight vigil for the uninsured on Feb. 16.

Georgia members met with the staff of Sens. Ossoff and Warnock, as well as Reps. Nikema Williams, Barry Loudermilk, and Rick Allen, to discuss the harms of Medicare Advantage and to encourage support for the Rep. Jayapal and Sen. Warren letters to CMS. Participants in these meetings included a large and engaged group of physicians, students, and advocates. On January 20, an op-ed by Dr. Belinda McIntosh and Dr. Toby Terwilliger was published in the Atlanta Journal-Constitution, raising awareness about the urgent need for a single-payer system. The chapter also co-hosted a candlelight vigil for the uninsured on February 16, featuring speakers and community members calling for universal health care. To support the Moral Injury campaign, the chapter hosted a one-hour training session focused on distributing the national survey to gather stories and data from health care workers.

To get involved in Georgia, contact Dr. Toby Terwilliger at toby.terwilliger@gmail.com.

Illinois

Drs. Sydney Doe (L) and Winnie Lin attend “Funny You Should Care” at Second City on Feb. 11.

Illinois chapter leaders Dr. Sydney Doe and Dr. Winnie Lin participated in Second City’s “Funny You Should Care” event to raise funds and share PNHP’s key talking points through comedy and performance. Dr. Doe also gave a talk on Medicare Advantage and the case for single payer at the Ethical Humanist Society in Skokie. Additionally, Dr. Monica Maalouf and Dr. Claudia Fegan took part in a virtual forum hosted by the Health & Medicine Policy Research Group on February 13. The chapter has also organized several legislative meetings to encourage support for Rep. Jayapal’s letter to CMS. On February 19, members met with Rep. Jan Schakowsky (represented by Drs. Peter Gann, Deborah Geismar, and Anna Fogel) and with Rep. Sean Casten’s staff (attended by Drs. Ameer Sharifzadeh and Peter Gann). On February 25, Colin Garon and Dr. Peter Orris met with Rep. Mike Quigley’s staff.

To get involved in Illinois, contact Dr. Sydney Doe at sydney.doe94@gmail.com.

Kentucky

Members in Kentucky have been active in both community outreach and media. They tabled at World Fest and the Pride Festival, distributing flyers and gathering petition signatures to promote Enhanced Medicare for All. Kentuckians for Single-Payer Health Care also helped reorganize the SNaHP chapter at the University of Louisville in February. Additionally, they regularly produce Single Payer Radio, covering topics such as reproductive rights, the dangers of Medicare Advantage, and broader issues in the U.S. health care system. PNHP information on Medicare Advantage is featured at events and on the radio.

To get involved in Kentucky, contact Kay Tillow at nursenpo@aol.com.

Maine

Maine members have been active on both the federal and state levels. Between January 29 and February 5, Maine AllCare board members and supporters met with staff from Sens. Angus King and Susan Collins, and Rep. Jared Golden, to express concerns about MA—specifically, its overpayments and the impact on patient care. They also urged each office to support Rep. Jayapal’s letter calling for reforms to the MA program. On the state level, Maine AllCare is supporting three state bills: a universal health care study bill, the creation of an All Maine Health Program, and a moratorium on private equity and REIT ownership of hospitals. In addition, Maine AllCare has launched an LTE team, resulting in over a dozen letters and op-eds published across major state newspapers in the past six months, advancing the message of publicly-funded universal health care.

To get involved in Maine, contact Dr. Henk Goorhuis at info@maineallcare.org.

North Carolina

The North Carolina chapter hosted their 30th Anniversary Annual Meeting on October 6, 2024, featuring Rose Roach as keynote speaker and a presentation by Dr. Diljeet Singh via Zoom. The chapter launched a new initiative, Action Hours, including one on February 4, 2025, to oppose the nomination of RFK Jr. as HHS Secretary, and another on March 10, 2025, focused on preventing cuts to Medicaid. Two chapter members were nationally recognized for their advocacy work: Rebecca Cerese received the Health Justice Advocate of the Year Award from Families USA and Dr. Eleanor Greene received the Founder’s Award for Excellence in Advocacy, presented by Dr. Vivek Murthy on behalf of Doctors for America at their National Leadership Conference in June 2024. The chapter also actively participated in PNHP webinars and has been engaged in educating colleagues and fellow advocates about the harms of Medicare Advantage and the need for a single-payer system.

To get involved in North Carolina, contact Dr. Eleanor Greene at eleanorgreene@northstate.net, or Dr. Conny Morrison at conny.morrison@healthcareforallnc.org.

Ohio

The Cincinnati chapter recruited five new members, including four physicians and one nurse, bringing their chapter roster from 15 to 20 members. Three members gave a combined 15 presentations on single-payer health care reform to audiences of physicians, nursing students, and community groups. In autumn, the chapter launched a petition drive urging Rep. Greg Landsman to support the Congressional Progressive Caucus’s efforts to reform Medicare Advantage. The campaign collected over 500 signatures, which were scheduled to be delivered to Rep. Landsman in person, and which most likely inspired him to sign Rep. Jayapal’s MA letter in March. The chapter has maintained an ongoing dialogue with Rep. Landsman and his health policy aide, providing research and articles on profiteering by MA insurers.

To get involved in Cincinnati, contact Dr. Philip K. Lichtenstein at lichtensteinphil1@gmail.com.

Virginia

Drs. Bob Devereaux (L) and Jay Brock join medical student Rachel Fox at Popular Democracy’s “March to Save Our Healthcare” in Washington, D.C. on March 12

The Virginia chapter has been active on multiple fronts. Members, especially Dr. Bruce Silverman and Sandra Klassen, worked with state legislators on a bill that would allow Medicare Advantage enrollees to switch to traditional Medicare without underwriting—an effort that was unsuccessful this session, but will be pursued again. The chapter also formed a coalition with Arlington Medicare for All and the Northern Virginia DSA to advocate for Medicare for All and oppose Medicare Advantage. Raymond Uymatiao, MS4, helped launch a new SNaHP chapter at Virginia Tech Carilion and spoke at the People’s Action protest at UnitedHealthcare in D.C. Additionally, fourth year medical student Rachel Fox spoke at a Popular Democracy-led rally that included both Rep. Jayapal and Sen. Sanders as speakers. She focused on fighting Medicaid cuts and MA overpayments.

To get involved in Virginia, contact Dr. Robert Devereaux at robdev56@icloud.com.

Washington

PNHP and SNaHP members attend the PNHP Annual Meeting in Chicago with Rep. Pramila Jayapal (front-center).

The Washington state chapter has been deeply engaged in coalition building and education. They serve on the Steering Committee of Health Care is a Human Right Washington and co-organized the first-ever Single-Payer Summit, bringing together representatives from 20 organizations committed to single payer. The summit group continues to meet regularly. The chapter also holds monthly meetings featuring speakers on timely health care issues and sent a delegation of 12 PNHPWA and SNaHP WA members to the PNHP Annual Meeting in Chicago.

To get involved in Washington, contact Dr. David McLanahan at mcltan@comcast.net.

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SNaHP Chapter Reports

SNaHP Rising (Western University)

SNaHP Rising (Western University) is among one of the newest chapters, and officially became recognized as a part of SNaHP on February 19. Their first meeting recruited eight medical students and included a discussion on the core arguments for single payer and the failures of MA. They also discussed the AAFP’s potential resolution opposing MA and encouraged students to submit their own testimonies to support.

To get involved with SNaHP Rising, contact Zollie Daily at zollie.daily@westernu.edu.

Florida SNaHP

Florida SNaHPers advocate for health care legislation during Lobby Day in Tallahassee on March 13.

Florida SNaHP members met with the offices of Reps. Maxwell Frost, Sheila Cherfilus-McCormick, Jared Moskowitz, and Frederica Wilson to encourage them to sign on to Rep. Jayapal’s letter calling for reform of Medicare Advantage. The chapter also hosted a powerful Town Hall with Reps. Jayapal and Cherfilus-McCormick to raise awareness about the dangers of Medicare privatization. The event drew 140 attendees on Zoom, and over 80 participants took action by emailing their representatives to oppose Medicare “Advantage.” In addition, the chapter held a successful Health Policy Week, adding over 60 new M1 members to their listserv and launching new student chapters at the UF undergraduate campus, UCF College of Medicine, and USF Morsani College of Medicine.

To get involved in Florida, contact Pat Haley at patrickhaley59@gmail.com.

FSU (Florida State University)

FSU (Florida State University) SNaHP members supported a February 2025 Town Hall featuring Rep. Pramila Jayapal and mobilized students during Medicare Open Enrollment with a national activist call. The chapter also met with Rep. Sheila Cherfilus-McCormick and participated in a June 2024 Town Hall with key health care leaders. Their efforts continue to raise awareness about the harms of Medicare Advantage and promote patient-centered reform.

To get involved with FSU SNaHP, contact Davalda Bellot at dmb12d@fsu.edu.

Health Care for All (Chicago College of Osteopathic Medicine)

The Health Care for All (Chicago College of Osteopathic Medicine) chapter hosted a screening and discussion of “The Healthcare Divide” to raise awareness about the disparities caused by our current health care system. They also organized a workshop on letter-writing campaigns, equipping participants with tools to effectively advocate for health care reform. Several members were actively involved in drafting and supporting resolutions related to Medicare Advantage, which were submitted to both the Illinois State Medical Society (ISMS) and the American Osteopathic Association (AOA).

To get involved with Health Care for All, contact Brittany Taylor at brittany.taylor1@midwestern.edu.

Northwestern SNaHP

In October 2024, Northwestern SNaHP students Samiya Manocha (M1) and Mo Kissinger (M4) collaborated with peers from other Illinois medical schools to write and submit a resolution to the Illinois State Medical Society (ISMS) urging greater transparency in Medicare Advantage plans. The resolution was recommended for adoption by committee and is set to be voted on in late April. From September to December 2024, students Emma Pauer and Laith Kayat (M2s) led a chapter book club on “Medicare for All: A Citizen’s Guide,” bringing members together for three in-depth discussions. The chapter also hosted a special event in December 2024, “A Conversation with Dr. Claudia Fegan,” where Dr. Fegan spoke to a large student audience about Medicare for All and international health care systems, sparking strong interest and dialogue.

To get involved at Northwestern, contact Becca Marcus at Rebecca.marcus@northwestern.edu.

University of Illinois College of Medicine – Peoria

The SNaHP chapter at the University of Illinois College of Medicine – Peoria held its first ever chapter meeting with an introductory lunch to kick off organizing efforts and build member engagement. Chapter leaders also attended the SNaHP conference, connecting with other medical students and advocates from across the country. In collaboration with UI Health residents and the Chicago PNHP chapter, the group began an investigation into billing practices at UI Health, aligning with broader efforts to uncover and address harmful health care system practices. They also shared the Moral Injury Survey with faculty to encourage participation and awareness.

To get involved in the Peoria chapter, contact Kelley Baumann at kbauma22@uic.edu.

Iowa SNaHP

Medical student Zach Grissom speaks during Sen. Bernie Sanders’ rally in Iowa City on Feb. 22.

The Iowa SNaHP chapter launched in fall 2024 and has quickly gained momentum. From having no formal structure in September, the group now has around 40 members on paper, with 17 actively involved in planning and executing events. Their programming is widely advertised to the entire College of Medicine MD and PA student body. The chapter’s first event, “Single Payer 101” with Dr. Arya Zandvakili, took place on October 24, 2024, followed by a student-led presentation on Medicare DISadvantage on December 4, 2024, which utilized Dr. Ed Weisbart’s “Naked Profiteering” slide deck to highlight the advantages of traditional Medicare over Medicare Advantage. Most recently, I-SNaHP members attended the Sen. Bernie Sanders rally in Iowa City on February 22, 2025, where Zach Grissom was one of the speakers who addressed the crowd before the Senator, speaking about MA and Medicaid work requirements.

To get involved with I-SNaHP, contact Zach Grissom at zach-grissom@uiowa.edu.

KYCOM (University of Pikeville – Kentucky College of Osteopathic Medicine)

In partnership with Midwestern University Chicago College of Osteopathic Medicine, the KYCOM (University of Pikeville – Kentucky College of Osteopathic Medicine) SNaHP chapter submitted a SOMA resolution on the harmful effects of MA. Serina Sajjad, Adam Sayler, and Sammy Jaber were key contributors to the resolution’s writing and editing. The chapter also implemented a Community Aid initiative within the school’s student-run free clinic, launching the Bear Cove, a mutual aid corner offering food, hygiene products, clothing, and reproductive health supplies. The initiative, led by Cassie Craig and in partnership with All Access EKY, includes ongoing donation drives, needs assessments, and plans to expand into harm reduction services like Narcan training and safe needle disposal. In February, the chapter launched a statewide medical debt relief campaign in collaboration with Undue Medical Debt, aiming to abolish $33 million in defaulted medical debt across Kentucky. They also hosted an on-campus presentation highlighting how MA’s practices limit care and increase corporate profit. This training supported their Medicare Advantage Bingo events at Myers Tower and Pikeville Nursing and Rehabilitation Center, where students educated residents using interactive games, word searches, and coloring sheets. The events were led by Sammy Jaber and Serina Sajjad and co-hosted with the KYCOM Geriatrics Club.

To get involved with KYCOM SNaHP, contact Evan Hawthorn at EvanHawthorn@upike.edu.

WMed SNaHP

WMed students launch their SNaHP chapter at a Nov. 21, 2024 kickoff meeting.

WMed SNaHP members launched their organizing efforts with a successful kickoff meeting on November 21, 2024. Chapter leadership presented on diabetes as a case for single payer health care to an audience of over 30 peers and gathered signatures for MI for Single Payer’s petition supporting the MICARE initiative for state-based Medicare for All. The chapter has also formed partnerships with Southwest Michigan DSA and Food Not Bombs, collaborating on two ongoing projects to serve the local community directly. In addition, chapter leaders attended the SNaHP Medicare Advantage meeting and have been distributing PNHP materials on Medicare Advantage to raise awareness among peers.

To get involved with the WMU Homer Stryker chapter, contact Genevieve Nicolow at genevieve.nicolow@wmed.edu.

Creighton SNaHP

The Creighton SNaHP chapter hosted two successful Undue Medical Debt fundraisers—Dance Off Debt on October 4 and a Bake Sale on January 27—raising over $8,500 to help eliminate medical debt. On the legislative front, members testified in support of a Nebraska state bill to strengthen protections against medical debt garnishment on January 24. Additionally, the chapter held meetings with the offices of Sen. Deb Fischer (2/11) and Rep. Don Bacon (2/12) to advocate for strengthening traditional Medicare and opposing Medicare Advantage rate hikes. The chapter also created and delivered an educational presentation, “How to Navigate the U.S. Health Care System,” for a local community organization. Accompanied by a handout and map translated into 13 languages, these materials were distributed at a local health fair and will soon be available on the chapter’s website to expand access even further.

To get involved with the Creighton chapter, contact Luci Lange at lkl94259@creighton.edu.

Jacobs SNaHP

In October, the Jacobs SNaHP chapter hosted a fun and educational SNaHP Trivia Night, with questions focused on single-payer health care. The event was held at a local bar and featured prizes for the top three teams, helping to engage students in a relaxed and informative setting. In addition to campus activities, the chapter has been collaborating with other SNaHP chapters across Western New York, meeting monthly to strategize on lobbying local politicians in support of health care justice and Medicare for All.

To get involved with the Jacobs SNaHP chapter, contact Dylan Wong at dkwong2@buffalo.edu or jacobssnahp@gmail.com.

SNaHP at NEOMED (Northeast Ohio Medical University)

In February, SNaHP at NEOMED (Northeast Ohio Medical University) board members Elsa Khan and Shannon Lam led a workshop as part of a required clinical skills and ethics course. Shannon Lam and Noyonikaa Gupta also published an op-ed in The Portager addressing concerns about proposed work requirements for Medicaid and Medicare. Members Helen Aziz and Shannon Lam also volunteered at the Teddy Bear Clinic to connect with children, helping foster an early interest in medicine and ease anxieties about visiting the doctor.

To get involved with the NEOMED SNaHP chapter, contact Shannon Lam at slam2@neomed.edu. 

DUCOM (Drexel University College of Medicine)

In August, the DUCOM (Drexel University College of Medicine) SNaHP chapter hosted a Single Payer 101 event to introduce incoming M1s to the concept of single-payer health care and the mission of SNaHP. Later in the year, former board member Justin Yeung organized a hybrid talk with Dr. Ed Weisbart, who presented on the dangers of Medicare Advantage followed by a Q&A session with medical students. In addition to educational events, the chapter also participated in voter registration canvassing during the summer and early fall, partnering with Penn Medicine to reach community members and promote civic engagement.

To get involved with DUCOM SNaHP, contact Kacie Wheeler at ducom.snahp@gmail.com.

SKMC (Sidney Kimmel Medical College)

This year, the SKMC (Sidney Kimmel Medical College) SNaHP chapter hosted several informative speaker events, including a session with Dr. Julie Qualtieri focused on Medicare Advantage and a visit from Dr. Joe Jarvis of Utah, who shared insights from the Utah Cares campaign and offered strategic lessons for Pennsylvania. Looking ahead, the chapter plans to increase event attendance and visibility on campus, beginning with an upcoming student-run workshop on the Affordable Care Act and threats to its subsidies under the Inflation Reduction Act. The chapter plans to continue outreach to local elected officials to promote single-payer policies and highlight the growing support among health care worker unions. In the policy space, the chapter is building connections with other student organizations at Jefferson. They are currently working with the Jefferson AMA chapter to organize a policy-writing workshop, with the goal of submitting single-payer focused resolutions to PAMED.

To get involved with the SKMC chapter, contact Emily Hashem at enh013@students.jefferson.edu.

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Responding to the UnitedHealthcare CEO Murder

Four months ago, the shocking news broke that the CEO of UnitedHealthcare had been shot and killed in Manhattan while on his way to the company’s annual investor conference. Public reaction to this event has been intense, sparking a national conversation about corporate control of health care and the deep frustration felt by Americans towards private insurance companies. This moment underscored a stark reality: Our health care system is in crisis, and people are suffering under the weight of corporate greed.

PNHP has been vocal in responding to this event, with our members highlighting the urgent need for Medicare for All as the only solution to the injustices perpetrated by private insurers. PNHP National Coordinator Dr. Claudia Fegan published a powerful op-ed in Common Dreams in early January, reflecting on her decades of difficult experiences, and how these are shared by millions of Americans who struggle to receive the care they need.

“I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers,” she wrote, “and in recent years I have seen this problem getting much worse. These are the stories that Americans are sharing in this fraught moment. We have to ask ourselves: Are we listening? And what are we going to do about it?”

The public reaction to this shooting has made one thing clear: Americans are fed up with private insurers profiting off of denied care, surprise bills, and administrative hurdles that make it harder for patients to get the treatment they need. As this story dominated the news cycle, PNHP leaders and members took the opportunity to shift the conversation toward real solutions—not just outrage, but action. Our members have been speaking out in the media, engaging in public discussions, and emphasizing that the only way to truly end the suffering caused by corporate insurers is to replace them with a single-payer Medicare for All system.

This moment is a wake-up call, and we cannot afford to ignore it. PNHP will continue to fight for a health care system that puts patients before profits, and we urge our members and supporters to channel their frustration into advocacy.

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PNHP in the News

News items featuring PNHP members

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Op-eds by PNHP members

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Letters to the editor by PNHP members

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Understanding Moral Injury in Health Care

Physicians for a National Health Program (PNHP) is partnering with the Robert Wood Johnson Foundation (RWJF) to study the impact of financialization on U.S. health care. Starting in the fall of 2024, and continuing through the summer of 2025, we will engage current health care professionals to better understand moral injury and distress, how these issues impact racial inequities in health care, and how best to remedy this worsening problem.

Take our brief moral injury survey

Toolkit: Share our moral injury survey

Dr. Diljeet Singh explains our research project

What is “moral injury?”

As health care has been transformed from an essential service to a profit-driven business, the morale of the entire workforce—including physicians, nurses, and allied health professionals—has suffered. This trend has led to shortages as professionals are retiring early, cutting back work hours, quitting clinical medicine, and tragically committing suicide in increasing numbers.

These responses have often been misdiagnosed as “burnout,” but the lack of efficacy of standard treatments for burnout has led insightful scholars such as Drs. Wendy Dean and Simon Talbot to identify “moral injury” as a more accurate culprit.

Moral injury in health care is described as the challenge of knowing what care patients need, but being unable to provide it due to constraints beyond physicians’ control. As a result, our focus on burnout is insufficient and, in fact, causes harm by leading to a reliance on ineffectual “wellness” programs and an obscuring of root causes. Without adequate data on moral injury, the ability of policymakers and stakeholders to address our health care crisis will remain limited.

Gaps in the literature

In an effort to better understand moral injury in health care, PNHP will survey workers throughout the medical profession and will conduct a series of 20-40 one-on-one interviews with currently practicing physicians. We will gather data points on the impact of financialization from our survey, and identify narratives from our interviews to more compellingly illustrate these data points. These elements will form the basis of our fall 2025 report, which will provide actionable recommendations for stakeholders.

Our project follows the rigorous practices of the Association for the Accreditation of Human Research Protection Programs (AAHRPP), and we have obtained Institutional Review Board approval by the independent Pearl IRB, along with our consultant at Cambridge Health Alliance’s institutional IRB.

See the following documents for specifics on our survey, and the broader moral injury project:

Take our moral injury survey

The first part of our moral injury project consists of an intake survey to help us better understand the impact of financialization in U.S. health care, and how it intersects with racial health inequities. You can take our 10-minute survey at pnhp.org/survey.

Please note the following to better understand our survey process:

  • Questions were developed in consultation with a working group of prominent physicians and academics, and through insights gleaned from a series of physician focus groups conducted over the summer of 2024.
  • Our main audience for the survey is physicians who are currently practicing in the U.S., but we are collecting survey responses from all health professionals.
  • We have secured Institutional Review Board (IRB) approval via Pearl IRB and Cambridge Health Alliance.
  • This survey functions as an intake tool for a series of 1:1 interviews to be conducted over the spring/summer.
  • We will release a high-level report of findings at PNHP’s 2025 Annual Meeting (Nov. 1-3 in Washington, D.C.), and will share this report with PNHP members, allies, and elected officials.
  • We will author an academic paper detailing the results of our moral injury research, which will be submitted for journal publication at the end of 2025.

For reference, we have uploaded a PDF version of our complete moral injury survey HERE.

Share our moral injury survey

To properly understand the impact of financialization on U.S. health care, and how it intersects with racial health inequities, we will need to engage with thousands of currently practicing physicians. This means tapping our active PNHP members and going beyond this cadre of single-payer activists.

We need you to share the pnhp.org/survey link with currently practicing physicians in your network! To help you with this outreach, PNHP has put together a toolkit that includes:

We’ve also developed a one-page info sheet with information about our moral injury project.

Dr. Toby Terwilliger provides outreach tips

Respecting your privacy

PNHP’s moral injury survey covers delicate topics and gives participants the opportunity to share experiences from their practice—as well as experiences with specific employers, insurers, and other parties.

Rest assured that survey responses will be anonymized through the use of unique ID numbers and that nobody outside of PNHP’s survey team will ever have access to individual replies.

We also ask survey respondents to share their email address, so we can follow up regarding potential 1:1 interviews. Please note:

  • Individuals who are not already in PNHP’s database can opt in to receive updates about our moral injury project.
  • If respondents are added to our email list, they can unsubscribe at any time (link at the bottom of all PNHP emails).
  • PNHP will never sell or share emails collected through our moral injury survey.

Moral injury workshop (Nov. 2024)

PNHP president Dr. Diljeet Singh helped lead a workshop on moral injury at our 2024 Annual Meeting in Chicago. Download Dr. Singh’s slideshow HERE.

Social media graphics

Use this graphic to encourage people in your network to take the survey. Download HERE.

Use this graphic to encourage people in your network to learn more about our moral injury project. Download HERE.

2024 Annual Meeting Materials

PNHP’s 2024 Annual Meeting in Chicago drew physicians, students, and health justice activists from across the country for a weekend of organizing, strategizing, and setting our agenda for the year ahead.

Please see below to access a selection of archival recordings, slideshows, and handouts from the meeting. To view photos from the meeting, visit our Flickr page.

During the conference, we encouraged attendees to post to social media using the hashtag #PNHP2024. Click HERE to read member tweets, and be sure to follow PNHP on Instagram, Twitter and Facebook for the latest on the Medicare for All movement.

Looking for materials from the Students for a National Health Program (SNaHP) Summit? Click HERE to access slideshows, photos, handouts, and more!

PNHP’s “Triple Aim” to advance our movement

PNHP president Phil Verhoef, MD, PhD kicked off our meeting by unveiling our “Triple Aim” of ending profiteering, improving traditional Medicare, and winning single payer (slideshow HERE).

Health Policy Update

PNHP past president Adam Gaffney, MD, MPH presented the latest data on the U.S. health crisis—from declining population health, to rampant profiteering, to onerous restrictions. Download Dr. Gaffney’s original slideshow HERE or an alternate visual presentation by Dr. Ed Weisbart HERE.

Bring Power to Truth: Fighting Medicare Advantage

SNaHP executive board members Shruthi Bhuma, M4 and Swathi Bhuma, M4 presented the main components of our campaign to stop Medicare profiteering: legislative, narrative, and organizing (slideshow HERE).

Welcome from Rep. Jan Schakowsky

Medicare for All cosponsor Rep. Jan Schakowsky (IL-9) welcomed PNHP members from across the country to Chicago, and urged us to keep pushing in the fight for single-payer reform.

Panel discussion: Reacting to the election

Featuring (R to L) Abdul El-Sayed, MD, DPhil; Alex Lawson, MPP; Wendell Potter; and A. Taylor Walker, MD, MPH. Moderated by Sanjeev Sriram, MD, MPH; and Emily Huff, M3

Workshops I: Campaigns for 2025

  • Growing Power within Medical Societies, presented by Eve Shaprio, MD, MPH; Shannon Rotolo, PharmD; Stephen Kemble, MD; and Donald Bourne, M3 (worksheet HERE).
  • Moral Injury: Let’s Talk About It, presented by Diljeet Singh, MD, DrPH; Carol Paris, MD; and Anand Habib, MD, MPhil (video recording HERE; slideshow HERE; worksheet HERE; moral injury survey HERE).
  • A Toolbox for Building Local Power, presented by Toby Terwilliger, MD; Robel Worku; and Brooke Adams, M1 (worksheets HERE and HERE).
  • Making Legislative Action Real, presented by Ed Weisbart, MD; Stephan Ramdohr; and Dan Doyle, MD (slideshow HERE; worksheet HERE).

Workshops II: Building Your Practical Skills

  • Recruiting and 1:1: How to Utilize your Network, presented by Andy Hyatt, MD; Jessica Schorr Saxe, MD; and Alankrita Olson, MD (worksheet HERE).
  • Tension is Part of Building Powerful Relationships of Accountability with our Legislators, presented by Hannah Willage; Belinda McIntosh, MD; and Lori Clark (slideshow HERE; worksheet HERE).
  • Building Powerful Coalitions, presented by Betty Kolod, MD; Brian Yablon, MD; and Alex Newell-Taylor
  • Communicating Clearly and Effectively, presented by Chiamaka Okonkwo, M4; Carol Paris, MD; Dixon Galvez-Searle; and Anika Thota (slideshow HERE; worksheet HERE; Dr. Paris’ letter to the editor HERE; moral injury survey HERE).
  • Running Inclusive and Effective Meetings, presented by Zach Gallin, M4; Jenn Sugijanto, M4; and Morgan Moore (worksheets HERE and HERE).

Telling your personal health care story

Carol Paris, MD; Douglas Robinson, MD; Emily Thompson, MD; and Phil Lichtenstein, MD talk about their experiences in the exam room during our “Communicating Clearly and Effectively” workshop.

PNHP timeline for 2025

Developed by meeting attendees reporting back from our campaign and skill-building workshops. Built by Ashley Duhon, MD and Ed Weisbart, MD (recoding HERE; slideshow HERE).

Keynote: Rep. Pramila Jayapal

Congresswoman Pramila Jayapal, lead sponsor of the Medicare for All Act in the U.S. House and chair of the Congressional Progressive Caucus, concluded our meeting with a dinner keynote address.

Students for a National Health Program (SNaHP) Summit

Medical and health professional students convened in Chicago for the annual SNaHP Summit on Nov. 15, 2024. During registration, students took in a wide-ranging poster presentation in the lobby.

Organizing for Human Rights

Committee of Interns and Residents president A. Taylor Walker, MD, MPH discussed her union’s organizing to pass two resolutions in support of Palestine.

Debriefing the 2024 election

Patrick Haley and Chiamaka Okonkwo led an interactive session responding to the federal election. Students wrote down both their immediate reactions and what gave them hope in the moment.

Welcome from Rep. Delia Ramirez

Medicare for All cosponsor Rep. Delia Ramirez (IL-3) welcomed students from across the country to Chicago, the “birthplace of community organizing.”

Launching the NEW SNaHP website

SNaHP media team leaders Griffin Johnson and Natalie Koconis did their best Steve Jobs impressions while launching the revamped student.pnhp.org website.

SNaHP Strategy in 2025

The SNaHP Summit started in earnest with presentations by Michael Massey (introduction, slideshow HERE); Shruthi and Swathi Bhuma (welcome to Chicago, slideshow HERE); Cortez Johnson (roll call); Max Brockwell and James Waters (strategic vision, slideshow HERE); and PNHP president Phil Verhoef, MD, PhD (Triple Aim, slideshow HERE).

Breakout Sessions I

  • Building Statewide/Regional SNaHP Power, presented by Samuel Marquina, Gitanjali Lakshminarayanan, Carson Hartlage, Laureen Haack, and Helen Bassett (slideshow HERE)
  • Start with Empathy: Talking Progress with Conservatives, presented by Cortez Johnson and John Kearney (slideshow HERE)
  • Becoming Us: Building Power through Effective 1:1, presented by Andrew Meci and Annabelle Brinkerhoff (slideshow HERE; worksheet HERE)
  • Writing Letters to Legislators, presented by Nina Silver, Halima Suleiman, and Priya Patel (slideshow HERE)
  • The Labor Movement in Medicine: Lessons for Organizers, presented by Kevin Hu, Tom Statchen, Andy Hyatt, and A. Taylor Walker (slideshow HERE)

Breakout Sessions II

  • Building A Powerful SNaHP Chapter, presented by Patrick Haley, Pritom Karmaker, and Mariam Tadross (slideshow HERE)
  • The Power of Campaign Building and Plans: How We Win, presented by Max Brockwell and Chiamaka Okonkwo (slideshow HERE)
  • Building knowledge about single-payer inside and outside of your med school curriculum, presented by Michael Massey and Constance Fontanet (slideshow HERE; worksheet HERE)
  • Post Election Debrief: Connect, Reflect, What’s Next, presented by James Moore and Wade Catt (slideshow HERE)
  • Becoming Us: Developing Powerful Testimony, presented by Donald Bourne, Carson Hartlage, Emily Huff, Allison Benjamin, Ksenia Varlyguina, and Mo Kinsinger (slideshow HERE)

Call to Action!

Shruthi and Swathi Bhuma (slideshow HERE); Allison M. Benjamin and Nina Silver; and Michael Massey led an interactive session where students made commitments to build power, take action, and work towards our North Star of Medicare for All.

PNHP National Office Staff

Ken Snyder – Executive Director

Contact for: organizational strategy; legislative and external relations; Board of Directors; development. Phone extension: 6025

Matthew Petty – Deputy Director

Contact for: memberships and donations; PNHP Annual Meeting; organizational operations and finance; human resources. Phone extension: 6024

Lori Clark – National Organizer

Contact for: membership committee; pediatricians Member Interest Group (MIG); chapters in CA, FL, GA, ME, MD, MA, OH; Students for a National Health Program (SNaHP). Phone extension: 6021

Rebecca Delay – National Organizer

Contact for: specialty-based Member Interest Groups (MIGs); medical society resolutions; medical conferences; Grand Rounds; chapters in AZ, CO, IL, IN, KY, MI, MN, NM, OR, PA, TN, TX, VA. Phone extension: 6020

Mandy Strenz – National Organizer

Contact for: anti-profiteering and Medicare (dis)Advantage campaign; membership committee; events calendar; chapters in AK, CT, DC, HI, IA, LA, MO, NH, NJ, NY, NC, ND, PR, RI, SC, VT, WA, WV, WI. Phone extension: 6026

Dixon Galvez-Searle – Communications Specialist

Contact for: email communications; social media (Facebook, Instagram, LinkedIn, and X/Twitter); website updates; branding and design. Phone extension: 6022

Anika Thota – Policy and Communications Specialist

Contact for: press inquiries; print and broadcast media; policy committee; policy questions. Phone extension: 6023

For a list of PNHP officers, directors, advisers, and past presidents, please see our Board of Directors page.

2024 Annual Meeting

Register HERE for the Nov. 16 meeting!

Note: Online registration will close on Sunday, Nov. 10 at 11:59 pm Central. Because of high demand, registration at the door may be limited.

PNHP Annual Meeting

Saturday, Nov. 16 (agenda available HERE)

  • Daytime program, 9:00 am – 5:00 pm
  • Dinner program, 6:00 pm – 8:00 pm

The PNHP Annual Meeting will be held in Chicago at the Venue SIX10, located at 610 S. Michigan Ave.

Sleeping rooms will be available at the Hilton Chicago, 720 S. Michigan Ave., for $229/night + $25/night mandatory destination charge (includes internet and athletic club access, and $25/day food/beverage credit). Sleeping room reservations may be booked in two ways:

  • Online HERE
  • Call 877-865-5320 and reference “PNHP Annual Meeting”

Sleeping room reservations must be made by Friday, Oct. 25. Note that the Hilton is completely booked for nights after Nov. 17.

SNaHP Summit

Friday, Nov. 15, 12:00 pm – 6:00 pm

The SNaHP Summit will be held in Chicago at Roosevelt University, located at 430 S. Michigan Ave. This event is not affiliated with Roosevelt University.

Scholarships are available to support student and resident attendance for both the SNaHP Summit and the PNHP Annual Meeting. Please note that the application deadline has passed, and we are in the process of awarding scholarships to qualified applicants. PNHP members and the public can support PNHP’s student outreach programs by making a GIFT to the Nicholas Skala Student Fund.

Speakers

Dinner Keynote: Rep. Pramila Jayapal

Congresswoman Pramila Jayapal represents Washington’s 7th District in the U.S. House and is chair of the Congressional Progressive Caucus and co-lead sponsor of the Medicare for All Act.

Meeting Chair: Dr. Philip Verhoef

Dr. Phil Verhoef is the president of PNHP, an adult and pediatric intensivist, and a clinical associate professor of medicine at the John A. Burns School of Medicine at the University of Hawaii-Manoa.

Health Policy Update: 

  • Dr. Adam Gaffney, Past President, PNHP; Assistant Professor of Medicine, Harvard Medical School
  • Shruthi Bhuma, executive board member, SNaHP; board advisor, PNHP; M4, Chicago Medical School
  • Swathi Bhuma, executive board member, SNaHP; board member, PNHP; M4, Chicago Medical School

Plenary Discussion Panel: 

  • Dr. Abdul El-Sayed, County Public Health Director, host of the America Dissected podcast, and author of Healing Politics and Medicare for All
  • Alex Lawson, Executive Director, Social Security Works
  • Wendell Potter, President, Center for Health and Democracy
  • Dr. A. Taylor Walker, President, Committee of Interns and Residents

See our agenda for a full lineup of speakers and workshops.

This conference will not be livestreamed in its entirety, but recordings of select sessions will be made available after the meeting.

Covid Safety Protocols

Please note that our medical experts recommend the following Covid safety precautions for the conference:

  • Staying home if you are experiencing symptoms suggestive of Covid, such as a sore throat, persistent cough, or fever
  • Testing immediately before the conference
  • Vaccination, particularly with one of the updated vaccines covering newer strains
  • Wearing a face mask while not actively eating or drinking
Although we recommend these precautions, we will not be requiring proof of vaccination or a negative test result.

Previous Annual Meetings

Click HERE to access archival material from last year’s Annual Meeting in Atlanta. Click HERE to view photos from the conference.

Attending the 2024 PNHP Annual Meeting and SNaHP Summit is entirely voluntary and requires attendees to abide by any applicable rules of conduct, or local or state laws, that may be announced at any time. Attendees acknowledge the highly contagious and evolving nature of Covid-19 and voluntarily assume the risk of exposure to, or infection with, the virus by attending the Meeting, and understand that such exposure or infection may result in personal injury, illness, disability, and/or death. Attendees release and agree not to sue any persons or entities responsible for coordinating or organizing the PNHP Annual Meeting and SNaHP Summit in the event that they contract Covid-19. Attendees agree to comply with all Covid-related procedures that may be implemented at the Meeting, including mask-wearing.

PNHP Newsletter: Spring 2024

Table of contents

Click the links below to jump to different sections of the newsletter. To view a PDF version of the shorter print edition of the newsletter, click HERE.

If you wish to support PNHP’s outreach and education efforts with a financial contribution, click HERE.

If you have feedback about the newsletter, email info@pnhp.org.

PNHP News and Tools for Advocates

Save the Date for our Annual Meeting in Chicago

Research Roundup

PNHP Chapter Reports

SNaHP Chapter Reports

Reclaiming Medicare for the Public

PNHP in the News

PNHP News and Tools for Advocates

PNHP Leads Fight Against Medicare Advantage

SNaHP Executive Board Member James Waters presents a Medicare Advantage update at the PNHP Annual Meeting in Atlanta on Nov. 12, 2023.

As controversies continue to build around the corporate-run Medicare Advantage (MA) program, PNHP has become a leader in the fight to crack down against its abuses and strengthen Traditional Medicare. First, in October, PNHP released a report quantifying the egregious levels of overpayments in the program. This report was covered extensively in the media and used in briefings with members of Congress, and has set the standard for discussing MA’s raiding of the Medicare Trust Fund. 

Beginning in January, PNHP chapters around the country began organizing efforts around two different letters circulating in both chambers of Congress regarding Medicare Advantage. One letter was sponsored by the insurance industry, and uncritically praised MA while calling for increased support for the program. The other letter, written by progressive members of Congress like Rep. Pramila Jayapal, Rep. Rosa DeLauro, Rep. Jan Schakowsky, Sen. Elizabeth Warren, and Sen. Sherrod Brown, outlined the many flaws in MA and the critical need to reform the program while improving benefits in Traditional Medicare.

PNHP staff, members, and allied organizations set up dozens of meetings with their Congressional representatives to ask them not to sign on to the pro-industry letter, and to instead sign on to the reform letter. PNHP members helped lead over 40 meetings with members of both the House and Senate, and were able to convince several members to sign on to the reform letter that had not done so the previous year. In total, around 50 House members and 10 Senate members signed onto the reform letter.

Alongside our organizing campaign, PNHP also conducted an extremely successful email campaign urging members to contact their representatives with a message about the two MA letters. Almost 20,000 messages were sent through our email form, sending a strong signal to members of Congress that their constituents care deeply about the need to protect Medicare from privatization.

PNHP’s campaign against Medicare Advantage will continue through the year. If you would like to get involved, please contact National Organizer Mandy Strenz at mandy@pnhp.org.

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PNHP Caps off 35th Anniversary at Annual Meeting

(L) PNHP and SNaHP members rally with local health justice groups to demand Medicaid expansion in Georgia on Nov. 12, 2023. (R) Dr. Camara Jones delivers the keynote address at the PNHP Annual Meeting on Nov. 11, 2023.

After a year of celebrating PNHP’s 35th Anniversary through organizing, fundraising, and activism, we capped everything off at our Annual Meeting in Atlanta. Things kicked off on Friday with the Leadership Training, featuring presentations and workshops from leaders in PNHP and SNaHP. On Saturday morning, the Annual Meeting opened with the always hotly anticipated Health Policy Update, delivered by PNHP past president Dr. Adam Gaffney and SNaHP executive board member James Patrick Waters. They touched on a wide range of topics, including declining life expectancy, the ongoing Medicaid unwinding, and the dangerous expansion of Medicare Advantage.

After another day of workshops on topics ranging from organizing to moral injury to reproductive justice, attendees gathered for this year’s keynote address, delivered by distinguished physician activist and former American Public Health Association president Dr. Camara Jones. Dr. Jones gave a thought-provoking and allegory-rich talk on recognizing and combating racial inequity, both in health and in U.S. society more broadly. 

Saturday night’s highlight was the 35th Anniversary Dinner. Members took the stage to reminisce on three-and-a-half decades of fighting for health care justice with PNHP, and to recognize national allies, past presidents, medical student leaders, and co-founders. At the end of the dinner, the Quentin Young and Nick Skala health activist awards were presented to Dr. George Bohmfalk, Dr. Diljeet Singh, and SNaHP leader Donald Bourne.

Sunday saw our SNaHP members gathered for their annual Student Summit—running their own workshops and learning from one another about activism and leadership. To end the weekend, meeting attendees piled into buses and headed off to a fantastically organized public action protesting hospital closures and demanding Medicaid expansion in Georgia. The action was even covered by the Atlanta Journal-Constitution! 

PNHP’s 35th anniversary initiatives were to build the future of our movement by supporting the work of SNaHP; ramping up our fight against corporate profiteering, with a particular focus on the so-called “Medicare Advantage” program; and greatly increasing our base of active physician members fighting for improved Medicare for All. We made substantial progress in all these areas in 2023, and will continue to do so in 2024.

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Heal Medicare: PNHP Launches Revamped Website

As part of PNHP’s campaign against Medicare profiteering, we have created a new website to help activists wade through the many complex issues related to both traditional Medicare and corporate-controlled Medicare Advantage (MA) plans. The new website is called HealMedicare.org, and contains many resources to help explain the dangers of MA, and how we can collectively fight back.

The two focuses of the website are education (clearly explaining the harm caused by corporations like Cigna, Aetna, and UnitedHealthcare) and activism (raising our voices and organizing an effective response). The website has already been used extensively in our 2024 MA letter campaign, and contains a legislative toolkit with a robust set of links, documents, and videos for anyone looking to engage their representatives. 

We will continue to update the site as our campaign evolves throughout the year. Please take a look, and share with anyone who is concerned for the future of our public Medicare!

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Meet Mandy, Our New National Organizer

Mandy Strenz, National Organizer

Previous Experience: I worked with PNHP-NY Metro as the Chapter Coordinator starting in 2021 – and before that in the fine jewelry world, with advocacy work solely in my spare time.

What drew you to PNHP? Healthcare access is a throughline in many issues I care about: climate, immigration, reproductive rights, anti-war efforts, LGBTQIA+ issues, etc. While single payer alone wouldn’t solve any of those issues, it has the potential to majorly alleviate some of the strain people feel around them. Also, I just love getting to work on things I care about every day, especially with people as committed as PNHP members are.

What are you looking forward to working on over the next 12 months? I’m looking forward to seeing PNHP chapters grow their power and influence both locally and nationally.

What’s a fun fact about yourself? I’ve yet to meet a fermented food I don’t adore – please give me some challenging ones to try!

Thanks to the generosity of donors to our 35th anniversary campaign, Mandy Strenz joins PNHP as the third member of our growing Organizing Team alongside Lori Clark and Rebecca Delay. Connect with Mandy at mandy@pnhp.org.

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Save the Date for our Annual Meeting in Chicago

Join us for PNHP’s Annual Meeting, scheduled for Saturday, Nov. 16 in Chicago at the Venue SIX10, located at 610 S. Michigan Ave.

Our annual Students for a National Health Program (SNaHP) Summit is scheduled for the preceding day (Friday, Nov. 15) at a TBD location in Chicago. Stay tuned for more information, including registration, at pnhp.org/meeting.

PNHP members rally for single payer near the headquarters of Blue Cross and Blue Shield in Chicago on Oct. 31, 2015.

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Research Roundup

Data Update: Health Care Crisis by the Numbers

Barriers to Care

Ketamine can be lifesaving, but is difficult to access: Although increasingly popular as an option for treatment-resistant depression, IV Ketamine treatments for mental illness are currently off-label and thus rarely covered by insurers, costing anywhere from $400 to $1000 per treatment. Esketamine, a nasal spray and the only ketamine drug approved for depression, carries an out-of-pocket cost of $784 a month for two inhalers. Emily Maloney, “Ketamine can be transformative for people with suicidal thoughts — if they can access it,” STAT News, 9/7/23.

Insurers deny critical treatment for eating disorders: In deciding whether to cover eating disorder treatment, insurers often emphasize metrics like weight and body mass index while minimizing patients’ serious psychiatric symptoms. For example, a teen couldn’t get her insurer to cover her eating disorder and suicidality, even after three separate clinicians vouched for her admission to a specialty program. In terms of total costs, a hospital stay for eating disorder treatment runs an average of $61,000. Of the 20 most expensive psychiatric stays among Washington youth in 2021, 40% involved those with an eating disorder. Hannah Furfaro, “Not sick enough: How insurance denials can delay lifesaving eating-disorder treatment,” Seattle Times, 9/10/23.

Abortion coverage limited or unavailable at many employers: Around one-fourth of large U.S. employers heavily restrict coverage of legal abortions or don’t cover them at all under health plans for their workers. 10% of large employers don’t cover abortion at all, and 18% cover it only in limited circumstances. In 2021, the median costs for people paying out-of-pocket in the first trimester were $568 for a medication abortion and $625 for an abortion procedure. By the second trimester, the cost increased to $775 for abortion procedures. Rachana Pradhan, “Abortion Coverage Is Limited or Unavailable at a Quarter of Large Workplaces,” KFF Health News, 10/18/23.

Insurance premiums rise for U.S. families: Premiums rose 7%, compared to just a 1% increase last year. The average premium is now just under $24,000 for families who get their coverage through employers (about 153 million people in the United States are covered under this type of insurance) The 7% increase is the largest since 2011, and was at least partially driven by high inflation. Cailley LaPara, “Health Insurance Premiums Now Cost $24,000 a Year, Survey Says,” Bloomberg, 10/18/23.

Large numbers of Americans struggle to pay for care: 43% of those with employer coverage, 57% with marketplace or individual-market plans, 45% with Medicaid, and 51% percent with Medicare said it was very or somewhat difficult to afford their health care. 54% percent of people with employer coverage who reported delaying or forgoing care because of costs said a health problem of theirs or a family member got worse because of it, as did 61% in marketplace or individual-market plans, 60% with Medicaid, and 63% with Medicare. Sara R. Collins et al., “Paying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer,” Commonwealth Fund, 10/26/23.

Child survivors of shootings face huge costs: Survivors’ health care spending increased by an average of $34,884—a 17.1-fold increase. Parents of survivors experienced a 30–31% increase in psychiatric disorders, with 75% more mental health visits by mothers, and 5–14% reductions in mothers’ and siblings’ routine medical care. Family members experienced substantially larger 2.3- to 5.3-fold increases in psychiatric disorders, with at least 15.3-fold more mental health visits among parents. Zirui Song et al., “Firearm Injuries In Children And Adolescents: Health And Economic Consequences Among Survivors And Family Members,” Health Affairs, November 2023.

Long term care causes dire financial issues: Among Americans who had $171,365 to $1.8 million in savings at age 65, those with greater long-term care needs were much more likely to deplete their savings than those who did not need long-term care. 23.6% of those who lived in a nursing home died broke. The median annual cost of a private room in a nursing home was over $100,000 in 2020, and a home health aide costs over $60,000. Six in 10 adults age 50 and older feel “mostly” or “somewhat anxious” about affording the cost of a nursing home, assisted living facility, paid nurse, or aide to assist them in retirement. Reed Abelson and Jordan Rau, “Facing Financial Ruin as Costs Soar for Elder Care,” KFF Health News, 11/14/23.

Thousands of U.S. rape victims unable to get an abortion: 65,000 rape-related pregnancies occurred in the 14 states which have passed near-total abortion bans since the Dobbs decision in 2022. Even for those states which provide exceptions for rape, abortions are extremely difficult to access. Texas alone, owing to its large population and total banning of abortion without exceptions, accounted for approximately 26,000 of these pregnancies. Jessica Glenza, “Nearly 65,000 US rape victims could not get an abortion in their state, analysis shows,” The Guardian, 1/25/24.

GoFundMe remains critical to paying for care: The annual number of U.S. campaigns on GoFundMe related to medical causes (about 200,000) was 25 times the number of such campaigns on the site in 2011. The company has estimated that roughly a third of the funds raised on the site are related to costs for illness or injury, but that could be an undercount as some campaigns are counted under different categories. Campaigns made an average of about 40% of the target amount, and there is evidence that this number has worsened over time. Elisabeth Rosenthal, “GoFundMe Has Become a Health Care Utility,” KFF Health News, 2/12/24.

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Medicare & Medicaid Issues

Unenrolled Medicaid-eligible adults have difficulty accessing care: 37% of adults who are eligible for Medicaid but not enrolled in the program and do not have private insurance report having a usual source of care, compared to 69.9% of Medicaid enrollees and 66.8% of Medicaid-eligible individuals with private insurance. Unenrolled Medicaid-eligible individuals are more likely to delay care due to cost concerns (21.4% compared to 7.3% of Medicaid enrollees and 9.5% of Medicaid-eligible individuals with private insurance). Compared to Medicaid enrollees, unenrolled eligible adults were also less likely to have visited a doctor within the last year (23.4% vs 65.4%), had a prescription filled (27.8% vs 67%), or stayed in a hospital (2.5% vs 12.6%). Bowen Garrett et al., “Medicaid-Eligible Adults Who Lack Private Coverage and Are Not Enrolled,” Urban Institute, August 2023.

Beneficiaries in Medicare Advantage report affordability problems: 22% of Medicare Advantage (MA) enrollees reported high health care costs that made them underinsured, compared with 13% on Traditional Medicare plus supplemental coverage. 21% of MA enrollees reported problems paying medical bills and debt, compared with 14% of those on Traditional Medicare. Despite the touting of dental benefits as part of MA plans, 30% of those with MA reported delaying or not getting dental care due to cost. Faith Leonard et al., “Medicare’s Affordability Problem: A Look at the Cost Burdens Faced by Older Enrollees,” Commonwealth Fund, 9/19/23. 

Georgia Medicaid enrollment is low: The program, which is known as Pathways and has work requirements, has only enrolled 1,343 residents in the 3 months since it began. The state previously said it delayed the reevaluations of 160,000 people who were no longer eligible for traditional Medicaid but could qualify for Pathways to help them try to maintain health coverage. But observers have said they have detected little public outreach to target populations. In addition to imposing a work requirement, Pathways limits coverage to able-bodied adults earning up to 100% of the poverty line, which is $14,580 for a single person or $30,000 for a family of four. Associated Press, “Georgia Medicaid program with work requirement has enrolled only 1,343 residents in 3 months,” 10/20/23.

Rural hospitals feel sting of Medicare Advantage growth: MA enrollment has increased fourfold in rural areas since 2010. However, its growth has imperiled the finances of small hospitals in these more remote regions, as their payments are often lower than traditional Medicare and are regularly delayed or never arrive from insurers. One profiled hospital, Mesa View, is owed $800,000 by MA plans for care already provided. Sarah Jane Tribble, “Tiny, Rural Hospitals Feel the Pinch as Medicare Advantage Plans Grow,”  KFF Health News, 10/23/23.

Halfway through Medicaid unwinding, millions disenrolled: Of the 94 million people enrolled in Medicaid and CHIP in March 2023, at the end of January, 32 million have renewed coverage and 16 million have been disenrolled. Since the start of unwinding, Medicaid enrollment has declined in every state, ranging from 32% in Idaho to 1% in Maine. Bradley Corallo, “Halfway Through the Medicaid Unwinding: What Do the Data Show?” KFF, 1/30/24.

Medicare Advantage profitability is down: Between 2019 and 2022, the profit margin in MA declined from 4.9% to 3.4%, while earnings per member declined 28%. Increased utilization is partially responsible; UnitedHealth posted its largest medical loss ratio of 85% in the fourth quarter of 2023. Humana, which relies heavily on Medicare Advantage for its business model, reported profits falling far short of expectations in its latest release and has lowered its guidance for the coming year to $16 in adjusted earnings per share. Its stock fell over 14% after the release of its last earnings report. Emily Olsen, “Medicare Advantage profitability is declining, Moody’s says,” Healthcare Dive, 1/30/24.

MA enrollees report issues with care and benefits: Larger shares of beneficiaries in MA plans than in traditional Medicare reported they experienced delays in getting care because of the need to obtain prior approval (22% vs. 13%) and couldn’t afford care because of copayments or deductibles (12% vs. 7%). 31% of MA beneficiaries reported using none of their supplemental benefits in the past year. Gretchen Jacobson et al., “What Do Medicare Beneficiaries Value About Their Coverage?” Commonwealth Fund, February 22, 2024.

MA home health patients get less care: The study compared more than 285,000 patients receiving home health care through MA and TM from 102 home health locations in 19 states. MA patients had a shorter home health length of stay by 1.62 days, and received fewer visits from all disciplines except social work. There were no differences between the two types of Medicare in inpatient transfers. MA patients had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively. MA patients were 5% more likely to discharge to the community compared with TM. Rachel A. Prusynski et al., “Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage,” JAMA Health Forum, March 1, 2024. 

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Pharma

States taking steps to reduce drug prices: As Medicare prepares to begin negotiating drug prices, states are taking matters into their own hands using Prescription Drug Affordability Boards. These boards set upper limits for prices paid by state and local governments, and sometimes even for commercial health plans as well. For instance, the Minnesota board will review select brand-name drugs or biologics for which the list price rose by more than 15% or more than $2,000 during any 12-month period or course of treatment lasting under 12 months. Ed Silverman, “Medicare may plan to negotiate drug prices, but some states are taking their own steps to lower costs,” STAT News, 10/11/23.

Insurers begin charging for COVID treatment: Paxlovid, the most popular antiviral COVID treatment, was covered by the government free of charge until the end of 2023. Pfizer announced that it would set the price for the drug at $1390 per course. When the U.S. government was purchasing the drug, it paid around $530 per course. The United States purchased around 24 million courses of Paxlovid. About 3.4 million doses had been given in 2023 at the time of the announcement. Michael Erman, “Pfizer to price COVID treatment Paxlovid at $1,390 per course,” Reuters, 10/18/23.

Sickle cell therapies are costly: The newly approved drugs, the first CRISPR-based gene therapies approved by the FDA, are known as Casgevy and Lyfgenia. Casgevy is priced at $2.2 million, while Lyfgenia has an even higher price of $3.1 million. These one-time therapies have prices comparable to the lifetime estimated cost of managing sickle cell disease, estimated at between $4 and $6 million. Many of the approximately 16,000 people estimated to be eligible for Casgevy in the U.S. are covered by Medicaid, which may be limited in its ability to cover the drug. Ned Pagliarulo, “Pricey new gene therapiest for sickle cell pose access test,” Biopharma Dive, December 8, 2023.

Pharma companies use patents to stifle competition: A study in JAMA found that pharmaceutical companies use “terminal disclaimers” to create “patent thickets” by filing dozens of patents on drugs that protect little of true value, but allow companies to sue to prevent the production of generic or biosimilar drugs. 48% of the 271 drug patents currently in litigation involved the use of terminal disclaimers. An analysis found a 200% increase in patents filed by companies that made few substantive changes to their drugs. From 2000 to 2015, the FDA approved 1,421 new drugs. The ratio of continuation patents increased from 0.6 in 2000 to 1.8 in 2015. These practices allow pharmaceutical companies to keep exclusivity for their drugs and keep their prices high. Ed Silverman, “Patent thickets and terminal disclaimers: How pharma blocks biosimilars from the marketplace,” STAT News, December 21, 2023.

Insulin becomes cheaper for many Americans: The three major insulin manufacturers have lowered the cost of insulin to $35 a month for most patients, and Medicare enrollees pay no more than $35 a month as part of provisions of the Inflation Reduction Act. The inflation-adjusted cost of insulin has increased 24% between 2017 and 2022. An estimated 8.4 million Americans rely on insulin to survive, and as many as 1 in 4 patients have been unable to afford their medicine. Experts have noted that manufacturers’ lowering of prices coincides with changes to Medicaid rebate rules that mean these companies will save hundreds of millions by lowering the price of their drugs. One of the companies, Eli Lilly, could avoid having to pay an additional $430 million in Medicaid rebates in 2024 by lowering their insulin price. Tami Luhby, “More Americans can now get insulin for $35,” CNN, January 2, 2024.

Senate Democrats investigate asthma inhaler prices: In the past five years, AstraZeneca, GlaxoSmithKline (GSK), and Teva made more than $25 billion in revenue from inhalers alone. One of AstraZeneca’s inhalers costs $645 in the U.S. but just $49 in the U.K. One of Boehringer Ingelheim’s inhalers costs $489 in the U.S. but just $7 in France. GSK’s Advair HFA costs $319 in the U.S. but just $26 in the U.K. About 25 million Americans have asthma, and about 16 million have chronic obstructive pulmonary disease (COPD), two conditions that could require the use of inhalers. Nathaniel Weixel, “Sanders, Democrats launch investigation into asthma inhaler pricing,” The Hill, 1/8/24.

Drugmakers hike prices on over 700 medications: The average price increase across the industry was about 4.5% at the beginning of 2024, slightly behind previous averages of about 5%. Two notable increases include Ozempic and Mounjaro, the weight-loss drugs that have exploded in popularity. Ozempic’s price rose 3.5% to $984.29 for a month’s supply, while Mounjaro rose 4.5% to about $1,000 for a month’s supply. Other increases listed include pain medication Oxycontin (9%), blood thinner Plavix (4.7%), and antidepressant Wellbutrin (9.9%). Aimee Picchi, “Drugmakers hiking prices for more than 700 medications, including Ozempic and Mounjaro,” CBS News, 1/18/24.

Americans pay more for drugs than people in other countries: Across all drugs, U.S. prices were 278% of comparison countries’ prices. U.S. gross prices for brand-name originator drugs were 422% of comparison country prices. The only category where Americans spent less was in unbranded generics, which accounted for 90% of U.S. prescription drug volume but only 8% of spending (compared to 41% of volume and 13% of spending for comparison countries). By contrast, brand-name originator drugs accounted for only 7% of U.S. prescription drug volume, but 87% of U.S. prescription drug spending (compared with 29% of volume and 74% of spending in comparison countries). Andrew W. Mulcahy, “International Prescription Drug Price Comparisons,” RAND Corporation, February 1, 2024.

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Health Inequities

Racial disparities in access to care for chronic pain among opioid addicts: A study of Medicare beneficiaries with chronic lower back pain and opioid use disorder found disparities in the time to receive chiropractic care. ​​Median time to chiropractic care was longest for American Indian or Alaska Native people at 8.5 days, followed by Black or African American people at 7 days, and shortest for Asian or Pacific Islander people at 0 days. After adjustment, Black or African American and Hispanic people had lower odds of receiving chiropractic care within 3 months of diagnosis compared with non-Hispanic White persons. Fiona Bhondoekhan et al., “Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD,” JAMA Network Open, 9/12/23.

Unionized nursing homes more likely to report worker issues: From 2016-2021, the compliance rate for reporting workplace injuries and illnesses in nursing homes was only 40%. A study found that two years after unionization, nursing homes were 31.1% more likely than nonunion nursing homes to report workplace injury and illness data to OSHA. Further unionization could help improve workplace safety in nursing homes, a sector with one of the highest occupational injury and illness rates in the US. Adam Dean et al., “The Effect Of Labor Unions On Nursing Home Compliance With OSHA’s Workplace Injury And Illness Reporting Requirement”, Health Affairs, September 2023.

Pharmacy deserts grow in vulnerable communities: Rite Aid, CVS, and Walgreens have announced plans to collectively close an estimated 1500 stores. These store closures often hit low-income Black and Latinx neighborhoods first. An estimated 1 in 4 neighborhoods are pharmacy deserts across the country. Although the number of pharmacies in the United States has stayed at around 64,000 since 2014, pharmacies are increasingly leaving low-income and majority Black and Latinx neighborhoods and expanding in predominantly White and middle to higher-income areas, widening gaps in access. Aaron Gregg and Jaclyn Peiser, “Drugstore closures are leaving millions without easy access to a pharmacy,” Washington Post, October 22, 2023. 

Young black males with ADHD are underdiagnosed and undertreated: The odds that Black students got diagnosed with the neurological condition were 40% lower than for white students, with all else being equal. For young black males, the odds were 60% lower. Black children are 2.4 times as likely as white kids to receive a diagnosis of conduct disorder compared with a diagnosis of ADHD. Claire Sibonney, “Underdiagnosed and Undertreated, Young Black Males With ADHD Get Left Behind,” KFF Health News, 11/9/23.

Disparities in infant mortality rate persist in Alabama: Although Alabama’s overall infant mortality rate fell from 7.6 deaths per 1000 live births in 2021 to 6.7 deaths in 2022, the gap between Black and white infant mortality persisted. Among Black mothers, the rate actually increased from 12.1 in 2021 to 12.4 in 2022, while for white mothers it dropped from 5.8 in 2021 to 4.3 in 2022. Summer Harrell, “Alabama sees decrease in infant mortality rate, but racial disparities persist,” ABC 33/40, 11/16/23.

Black Medicaid heart failure patients more likely to be hospitalized: 12.7 percent of Black patients who were previously diagnosed with heart failure and could enroll in Medicaid through the Supplemental Security Income (SSI) program had a preventable hospitalization. This is nearly twice the rate of white enrollees with heart failure, of which about 7.2 percent experienced preventable hospitalizations. This effect was present in the pooled sample of 11 states for which race of patients could be assessed. In general for heart failure, asthma/COPD, and diabetes, preventable hospitalization rates were substantially higher for adults eligible for Medicaid through SSI compared with adults eligible for Medicaid through other pathways. Claire O’Brien et al., “Preventable Hospitalizations among Adult Medicaid Enrollees in 2019,” Urban Institute, January 23, 2024.

Health care workers say racism in care is a major issue: 47% of U.S. health care workers said they witnessed discrimination against patients, and 52% said that racism against patients was a major problem. Employees at health facilities with a higher percentage of Black or Latino patients witnessed higher rates of discrimination. At hospitals with a majority of Black patients, 70% of workers said they witnessed discrimination against patients based on their race or ethnicity. For hospitals with mostly Latino patients, that figure was 61%. 59% of workers younger than 40 said they faced stress due to discrimination, compared with 26% of workers 60 or older. Ken Alltucker, “Nearly half of health care workers have witnessed racism, discrimination, report shows,” USA Today, 2/18/24.

Fertility treatments out of reach for the poor: A round of IVF can cost around $20,000. For comparison, the maximum allowed income for a family of two on Medicaid in New York is just over $26,000. Although Medicaid pays for about 40% of births in the United States, and 46 states and the District of Columbia have elected to extend Medicaid postpartum coverage to 12 months, fertility treatments are still not covered under Medicaid. By contrast, 45% of companies with 500 or more workers cover IVF and/or fertility drug therapy. Michelle Andrews, “If You’re Poor, Fertility Treatment Can Be Out of Reach,” KFF Health News, February 26, 2024.

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Profiteers in Health Care

Medical device manufacturer reaches settlement on breathing device defects: Philips Respironics agreed to pay $479 million to settle claims that its defective continuous positive airway pressure (CPAP) devices spewed flecks of foam and gasses into the lungs of patients, causing respiratory illness and even lung cancer. More than 105,000 injuries and 385 reports of deaths that were possibly related to the foam breakdown in Philips machines have been reported to the F.D.A. Christina Jewett, “CPAP Maker Reaches $479 Million Settlement on Breathing Device Defects,” New York Times, 9/7/23. 

FTC sues private equity group for attempting to create anesthesia monopoly: The firm, Welsh Carson, owns U.S. Anesthesia Partners (USAP). The firm bought competing doctor groups in its markets to gain leverage over commercial health insurers and paid shareholders large sums by saddling the company with billions of dollars in debt. As it has grown to be by far the largest anesthesia provider in Texas, it has raised prices higher than all of its competitors to match. As of early 2020, UnitedHealthcare reported that it reimbursed USAP at rates 95% higher than its in-network median for Texas and 65% higher than the Houston average. Bob Herman and Tara Bannow, “FTC sues private equity firm Welsh Carson, U.S. Anesthesia Partners for allegedly creating a monopoly,” STAT News, 9/21/23.

Columbus hospitals relieving hundreds of millions in medical debt: Four regional hospitals are relieving approximately $335 million owed by hundreds of thousands of local residents for care received between 2015-2020. Columbus residents are eligible if they earn between 200-400% of the federal poverty line, which is about $55,500-$111,000 for a family of four. This is expected to impact around 340,000 local residents, the city estimates, with the average amount forgiven coming to nearly $1,000. Tyler Buchanan, “Columbus hospitals relieving $335M in medical debt,” Axios, 10/17/23.

UnitedHealth sued over MA denials: The lawsuit alleges that United used an AI tool to deny care to beneficiaries. According to plaintiffs, Medicare Advantage members appealed less than 1% of post-acute care denials, but 90% of those denials were reversed. UnitedHealthcare cut off hospice coverage for a patient named in the lawsuit two months after his admission, deeming it medically unnecessary and denying an appeal. The patient’s family spent as much as $168,000 out of pocket for him to remain at the hospice provider until his death. Another patient had a stroke at age 74 in October 2022 and United denied coverage for 20 days of nursing home care he received, then rejected multiple appeals, the lawsuit claims. His family paid more than $70,000 as a result. Nona Tepper, “UnitedHealth sued over AI, Medicare Advantage denials,” Modern Healthcare, 11/14/23.

Profit-seekers harm patients in assisted living: More than 800,000 older Americans reside in assisted living facilities. Most residents have to pay out-of-pocket because Medicare doesn’t cover long-term care and only a fifth of facilities accept Medicaid. The industry runs operating margins around 20%, and often charges residents with extensive needs $10,000 or more a month. The national median cost of assisted living is $54,000 a year. Investigations have found that facilities have billed residents $50 per injection, $12 for a single blood pressure check, and $93 a month to order medications from a pharmacy. Jordan Rau, “Senate Probes the Cost of Assisted Living and Its Burden on American Families,” KFF Health News, 1/25/24.

Senators grill pharma CEOs on company practices: In a hearing, Senator Chris Murphy pointed out that pharmaceutical company Johnson and Johnson spent $17 billion on stock buybacks and dividends compared to $14 billion on research and development. Senator Benrie Sanders said that Bristol Meyers Squibb charges patients $7,100 per year for blood-clot drug Eliquis in the U.S., while the same product can be purchased for $900 in Canada and just $650 in France. In 2022, prices for brand-name drugs in the U.S. were at least three times higher than those in 33 other wealthy nations. Max Zahn, “Big Pharma CEOs grilled on Capitol Hill over drug prices: 4 key takeaways,” ABC News, 2/8/24.

Private equity investment in Medicare Advantage is down: In 2023, investor groups made just four MA-related deals, the lowest number since 2017. At the peak of investment in 2021, private equity groups made 19 such deals, which then declined to 12 in 2022. From 2016 to 2023 in total, private equity groups invested in 80 Medicare Advantage companies. 45 of these investments were “add-on acquisitions” in which a Medicare Advantage company was purchased by another business the investors already owned. Nona Tepper, “Private equity Medicare Advantage investment slumps: report,” Modern Healthcare, 2/13/24.

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Studies and analysis of interest to single-payer advocates

“Taking Advantage: How Corporate Health Insurers Harm America’s Seniors,” Physicians for a National Health Program, May 2024. “Ultimately, the effect of enrolling in MA on the care of millions of patients is decidedly negative. The existing evidence demonstrates that MA is not doing what it promised to do, and what its participating insurers are overpaid billions to do; far from improving quality of care or outcomes, Medicare Advantage is leaving beneficiaries, health care workers, and our health care system worse off, all in the name of profit.”

“What Do Medicare Beneficiaries Value About Their Coverage?” by Gretchen Jacobson, Faith Leonard, Elizabeth Sciupac, and Robyn Rapoport, Commonwealth Fund, 2/22/24. “Delays in care resulting from prior approval requirements or unaffordable cost-sharing expenses were more likely to be reported by beneficiaries in Medicare Advantage than in traditional Medicare.”

“The burden of medical debt in the United States,” by Shameek Rakshit, Matthew Rae, Gary Claxton, Krutika Amin, and Cynthia Cox, Peterson-KFF Health System Tracker. “The SIPP survey suggests people in the United States owe at least $220 billion in medical debt. Approximately 14 million people (6% of adults) in the U.S. owe over $1,000 in medical debt and about 3 million people (1% of adults) owe medical debt of more than $10,000. While medical debt occurs across demographic groups, people with disabilities or in worse health, lower-income people, and uninsured people are more likely to have medical debt.”

“Restrictiveness of Medicare Advantage provider networks across physician specialties,” by Yevgeniy Feyman, Jose Figueroa, Melissa Garrido, Gretchen Jacobson, Michael Adelberg, and Austin Frakt, Health Services Research, 4/9/24. “Our findings suggest that rural beneficiaries may face disproportionately reduced access in these [MA] networks and that efforts to improve access should vary by specialty.”

“Older Americans Say They Feel Trapped in Medicare Advantage Plans,” by Sarah Jane Tribble, KFF Health News, 1/5/24. “Enrollment in Medicare Advantage plans has grown substantially in the past few decades, enticing more than half of all eligible people, primarily those 65 or older, with low premium costs and perks like dental and vision insurance. And as the private plans’ share of the Medicare patient pie has ballooned to 30.8 million people, so too have concerns about the insurers’ aggressive sales tactics and misleading coverage claims.”

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PNHP Chapter Reports

California

In California, multiple chapters continue their work on single payer and related issues. PNHP-Ventura members have created and delivered presentations around Medicare Advantage and Medicare privatization as part of grand rounds with very positive reception. The chapter also worked on an effort to pass a Ventura City Council resolution in favor of single payer. PNHP-Humboldt members have also been presenting on MA to various senior community groups, political organizations, and local events. The chapter was even able to place ads about the dangers of MA in local newspapers. Finally, PNHP-Chico, which recently restarted activities, has been delivering informational presentations, making calls to Senators to oppose cuts to social services, and planning future events.

To get involved in California, please contact Dr. Nancy C. Greep at ncgreep@gmail.com.

Indiana

Members of Medicare for All Indiana march in a local Independence Day parade in July 2023.

Members of Medicare for All Indiana have been hard at work together with SNaHP members passing resolutions at the Indiana State Medical Association. These resolutions include supporting Medicaid access, calling on non-profit hospitals to honor their charity care obligations, and protecting voting rights and democracy. In addition, members presented on Medicare for All at the League of Women Voters’ annual meeting in June, and gave multiple presentations on Medicare privatization throughout the year, including tabling at Farmers’ markets. The chapter also sponsored showings of American Hospitals in September.

To get involved in Indiana, please contact Dr. Rob Stone at grostone@gmail.com.

Kentucky

Members in Kentucky led a protest at Humana headquarters in downtown Louisville, demanding an end to denials of care, the right to choose your doctor, an end to forced placement in MA, and the enactment of Medicare for All. The chapter also gave several presentations and hosted webinars on value-based care, single payer, and other topics. Finally, the chapter successfully persuaded the newspaper known as the Kentucky Lantern to cover the story of Baptist Health hospitals and physicians ending contracts with Medicare Advantage companies.

To get involved in Kentucky, please contact Kay Tillow at nursenpo@aol.com.

North Carolina

Members of Health Care Justice – NC march in the MLK Day parade in Charlotte on Jan. 13, 2024.

In Asheville, members of Health Care for All Western North Carolina (HCFAWNC) have worked on a number of different initiatives. In October, the chapter presented to Burke County Democrats, and in November, organized a screening of the documentary “Healing US”, adding several new members to the chapter from this event. In January, members met with North Carolina House Representative Caleb Rudow to discuss single payer and his constituents’ need for it. Members also met with Senator Ted Budd  to inform him of the failures of Medicare Advantage plans and to ask him not to sign the pro-MA letter.

To get involved in HCFA-WNC, please contact Terry Hash at theresamhash@gmail.com.

Washington

In Washington, members continued their tradition of holding monthly Zoom meetings with a theme and speaker. These included a report-back from four members and eight SNaHP students from around the state who attended PNHP’s 35th Anniversary Annual Meeting in Atlanta. The chapter also raised more than $20,000 in contributions for its George Martin Student Scholarship Fund, which provides support for activities of the 5 SNaHP Chapters in our region. Members worked hard to develop deeper and more productive collaboration with other organizations in the region to fight against the privatization of Medicare. These include Puget Sound Advocates for Retirement Action, Health Care for All WA, and Health Care is a Human Right WA. Finally, members have been writing and circulating sign-on resolutions, advocating for Single-Payer with state and Congressional legislators, and planning for public meetings and actions in the Spring of 2024.

To get involved in Washington, please contact Dr. David McLanahan at mcltan@comcast.net.

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SNaHP Chapter Reports

Florida State University

SNaHP Students at Florida State University have focused on recruitment and collaboration. The chapter is planning to table at several student activity fairs, and has recruited members into leadership positions in the organization. Members attended a virtual town hall with Rep. Maxwell Frost in the fall, and sent students to health care focused events around Tallahassee. The chapter also continues to collaborate with other units at FSU College of Medicine on access to care for racial and ethnic minority populations. In the coming months, students will be looking to collaborate more closely with LMSA and Pride groups in the medical school.

To get involved at Florida State University, please contact Dr. Xan Nowakowski at alexandra.nowakowski@med.fsu.edu.

Hofstra University

The SNaHP chapter at the Hofstra University Zucker School of Medicine hosted a single payer 101 lecture presented by Dr. Oliver Fein in October. Students had the opportunity to learn about the basics of single payer and how it compares to our current health system in achieving affordable and universal health care coverage.  Students also organized a letter writing and introduction to advocacy event. In this event, medical students learned the ins and outs of engaging in advocacy and the democratic process. These students then wrote to their state and national representatives to express support for a number of health policies, including single payer. Many students also wrote to state legislators in support of the New York Health Act.

To get involved at Hofstra University, please contact Brien Maney at bmaney1@pride.hofstra.edu. 

UNC-Charlotte

UNC-Charlotte students grow their SNaHP chapter at the school’s Student Org Showcase on Jan. 18, 2024.

Students at the undergraduate chapter of UNC-Charlotte have held several meetings on different topics. One meeting was on understanding the legislation of health care, where students heard about the legislative side of Medicare for All from Dr. George Bohmfalk and Megan Dunn. Another meeting was on reproductive justice and healthcare, held in collaboration with the UNC-Charlotte Reproductive Justice Collective to discuss how reproductive freedom relates to Medicare for All. This event was organized using information from the reproductive justice session at the PNHP Annual Meeting. The last event held was on access to mental health care, and how Medicare for All can help eliminate barriers to accessing mental health care.

To get involved at UNC-Charlotte, please contact Kayla Walker at kwalk100@uncc.edu. 

University of Florida

University of Florida students and their allies celebrate the passage of a Medicare for All resolution in Alachua County, Fla. on Dec. 12, 2023.

Students at the University of Florida worked in collaboration with groups such as Medicare for All Florida and Alachua County Labor Coalition to pass a resolution in Alachua County in support of Medicare for All. The resolution passed on December 12th. The chapter also hosted 4 SNaHP events during Health Policy week for first-year medical students with local speakers and PNHP speakers Dr. Ed Weisbart, Dr. Marvin Malek, and Dr. Betty Keller. Finally, the chapter had great success with recruitment, increasing its membership from just 4 to 34 students in the last months.

To get involved at the University of Florida, please contact Patrick Haley at phaley1@ufl.edu. 

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Reclaiming Medicare for the Public

In late winter, legislators in the U.S. House and Senate sent a pair of letters to the Centers for Medicare and Medicaid Services, urging administrators to crack down on delays and denials in the so-called “Medicare Advantage” program—and to make sorely needed improvements to traditional Medicare. These letters were championed by Reps. Jayapal, DeLauro, and Schakowsky, and by Sens. Warren and Brown.

PNHP members were instrumental in convincing 60 Representatives and 10 Senators to sign on. We sent thousands of emails and met with dozens of legislators to talk about the dangers of Medicare profiteering.

For more information about how you can get involved with our legislative campaign, visit HealMedicare.org or email National Organizer Mandy Strenz at mandy@pnhp.org.

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PNHP in the News

News items featuring PNHP members

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Op-eds by PNHP members

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Letters to the editor by PNHP members

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Taking Advantage

How Corporate Health Insurers Harm America’s Seniors

Physicians for a National Health Program, May 23, 2024

Table of Contents

To view a PDF version of this report, click HERE for an interactive (web-friendly) version, HERE for a printable full-color version, and HERE for a printable black & white version.

To view a one-page printable handout, click HERE for full color and HERE for black & white.

Executive Summary

Medicare Advantage (MA), the privately-administered version of Traditional Medicare (TM), is causing significant harm to America’s patients, providers, and health care system. The insurers who run MA plans claim that they lead to better patient care and outcomes while saving money, but this is far from the truth.

Patients who sign up for Medicare Advantage are forced to deal with narrow networks which heavily restrict their access to physicians and hospitals, and are often misled about the size of these networks through inaccurate listings. They must seek prior authorization for many of the tests, treatments, and other procedures ordered by their doctor, often waiting days or weeks just to be inappropriately denied approval for necessary health care. These delays can have serious consequences for a patient’s health, even sometimes resulting in death.

MA plans aggressively advertise their supplemental perks, particularly their offering of dental, vision, and hearing benefits. However, plan benefits are often highly limited and do not come close to meeting the needs of enrollees. Even worse, patients in MA who become seriously ill or develop chronic conditions end up paying thousands of dollars for their care, often struggling to afford treatment and incurring medical debt in the process. These issues often have a disproportionate impact on the most vulnerable communities, reinforcing inequities in health care access and outcomes.

When patients encounter these issues in MA and wish to switch back to Traditional Medicare, they often find that they are unable to do so. In all but four states, regulations allow insurers to deny Medigap coverage to patients who have been in MA for more than a year. Without a Medigap policy to cover additional costs, Traditional Medicare is not an affordable option for many seniors who are then forced to remain in MA despite its many flaws.

MA doesn’t just hurt patients. Physicians, nurses, and other health care workers face serious barriers to caring for patients as a result of the excessive administrative burden placed on them by MA insurers. These workers must spend hours filling out authorization forms and fighting with insurers to get necessary care approved, limiting the time they can spend on their actual jobs. MA plans also frequently delay payments for the care of enrollees, or even refuse to pay altogether, causing serious financial harm to hospitals and medical practices that have limited resources to begin with.

Medicare was created to serve the people, and MA betrays that promise. We must rein in the abuses of MA insurers, eliminate profit-seeking in Medicare and beyond, and put an end to these egregious harms.

By the Numbers

  • 11.1-20.5 million: Hours per year wasted by medical practices on Medicare Advantage prior authorization requests
  • 11.7 million: Number of MA beneficiaries in a “narrow network” plan that excludes more than 70% of physicians in their county, based on 2017 KFF study (i) and STAT estimate of 2024 enrollment (ii)
  • 7.3 million: Number of MA beneficiaries who are underinsured based on their reporting of high health care costs, based on 2023 Commonwealth Fund study (iii) and STAT estimate of 2024 enrollment (iv)
  • 36: Number of studies cited in this paper collectively finding negative outcomes for patients and providers in MA
  • 2x: Increased likelihood of death after pancreatic surgery in cancer patients with MA, based on study in the Journal of Clinical Oncology (v)

Introduction

Insurance corporations in the privatized Medicare Advantage program are harming millions of America’s most vulnerable, while costing the Medicare Trust Fund tens of billions more than if those people enrolled in Traditional Medicare. These insurers force patients and health care workers alike to deal with unjustifiable prior authorization requirements, limited networks, endless denials of care, and inadequate coverage, severely disrupting care in the name of financial gain. This report will summarize, through a review of relevant academic literature, research, journalism, and original interviews conducted by PNHP, the many ways in which corporate-run Medicare harms both patients and health care workers.

Medicare Advantage, also known as MA or Medicare Part C, is a privately administered insurance program that uses a capitated payment structure, as opposed to the largely fee- for-service (FFS) structure of Traditional Medicare or TM. Instead of paying directly for the health care of beneficiaries, the federal government gives a lump sum of money to a third party (usually a commercial insurer) to “manage” patient care.

“Managed care” has promised two benefits: to save money, and to improve patient outcomes. Advocates of the insurance industry assert that private insurers, by dint of their profit incentive, will do a better job at preventing unnecessary expenses and promoting efficient spending. However, as we detailed in a previous report, MA has failed to realize any true savings, and in fact transfers tens of billions of dollars from taxpayers to corporations each year. (1) But what of the second measure? Even if Medicare Advantage is more expensive than Traditional Medicare, does it provide better care?

Insurers will tell you that the answer is a clear “yes,” using the same logic as when speaking about savings. After all, it’s taken for granted that companies must satisfy their customers in order to stay competitive and stay in business. This logic is both deceptively simple and deeply flawed. The literature comparing quality and outcomes of care between MA and TM challenges the claims of insurers. The Medicare Payment Advisory Commission (MedPAC), the most authoritative source of data and analysis on the Medicare program, has found no consistent pattern of better performance or outcomes under MA, despite its higher costs. (2) What’s more, the agency notes that the practice of “favorable selection” may skew quality and outcomes data in favor of MA. (3) By signing up less costly and thus generally healthier patients, insurers make it seem as though they do a better job of keeping patients healthy. (4) Even with this leg up, there is no persuasive evidence that MA outperforms TM on the whole. Insurers do not report much of the data that could help answer open questions about care in MA, further calling into question their claims about increased quality. (5)

Contrary to what insurers say, quality of care is often not the reason that beneficiaries enroll in an MA plan. They may be drawn in by misleading and aggressive marketing, as 17% of seniors have reported that advertisements led them to believe something about an MA plan that they later found out was not true. (6) They may sign up out of financial necessity, if they are unable to afford monthly TM premiums plus a supplemental Medigap policy. Their employer may only pay retiree benefits to an MA plan, a practice that has caused controversy around the country. (7) Or, most insidiously, they may be unhappy with their MA coverage but unable to switch to TM due to regulations detailed later in this paper. MA plans keep their customers through captive practices, not superior service. They make money not by providing the best medical services, but by withholding them. Ultimately, the effect of enrolling in MA on the care of millions of patients is decidedly negative. The existing evidence demonstrates that MA is not doing what it promised to do, and what its participating insurers are overpaid billions to do; far from improving quality of care or outcomes, Medicare Advantage is leaving beneficiaries, health care workers, and our health care system worse off, all in the name of profit.

Patient Harms: Restricting Access Through Networks

To examine the harm that MA does to patients, it is logical to begin with the act of seeking care from a physician or other provider. A key feature of Traditional Medicare, one which is both widely known and widely beloved, is that beneficiaries can access care at nearly any hospital or doctor in the country. The vast majority of practitioners and physicians in the U.S. participate in the program, and receive additional benefits to do so. (8) With TM, there are no out-of-network fees or differences in payments between providers. This is not the case in MA.

Medicare Advantage insurers employ networks just the same as nearly any other commercial insurance policy. Over half of MA plans are health maintenance organizations (HMOs), which tend to be more restrictive than other plans, featuring smaller networks, little out-of-network coverage, and referral requirements for specialist care. (9) These HMOs also enroll the greatest number of MA beneficiaries–around 62% of the total beneficiary population based on estimates from 2021. (10)

For most insurance plans, the ostensible goal of establishing a network is to negotiate lower payment rates with a smaller set of providers. (11) However, when it comes to MA, payment rates are largely set near or at those of Traditional Medicare, so rate negotiations are less of an incentive. Instead, narrow networks are formed with health systems that have lower utilization rates, as a means of saving money for the insurer. (12) In addition, insurers try to form networks using providers who can help them to achieve high star ratings in MA’s quality bonus program, as the ensuing reimbursement bonuses translate into extra profits for the insurer. (13) It is worth noting that the quality bonus program itself is highly flawed, and high star rating plans do not necessarily deliver better care to MA beneficiaries. (14)

The consequence of these financial incentives is that narrow physician networks are very common in Medicare Advantage. A study from KFF found that a little over one in three MA plans (35%) had a “narrow” physician network, meaning one that excluded more than 70% of physicians in a given county. (15) A further 43% of plans had “medium” networks, with anywhere from 30-69% of physicians included.

Only 22% of plans had “broad” networks that included more than 70% of physicians in the county area. On average, plans excluded over half of physicians in a county. (16) Although percentages of narrow networks for hospitals are lower, on average MA plans still only cover just over half (51%) of hospitals in a county. (17) Predictably, MA insurers often fail to meet the network adequacy standards that are set for them by the Centers for Medicare and Medicaid Services (CMS). (18)

These narrow networks persist across a variety of different specialties and categories of care. Multiple studies have found that psychiatrists are some of the most heavily restricted specialists in MA networks, with nearly two-thirds of plans covering less than 25% of psychiatrists in the network service area. (19) According to KFF’s physician study, 36% of assessed plans were even more narrow, with less than 10% of psychiatrists in the county included. (20) KFF also found that close to one-fifth of MA plans included less than five cardiothoracic surgeons, less than five neurosurgeons, less than five plastic surgeons, and less than five radiation oncologists. (21)

Evidence shows that patient demographics affect network size as well. Physicians who care for the greatest number of patients who are dual-eligible for Medicare and Medicaid (meaning patients who are both elderly/disabled and also struggling financially) have been found to have a lower chance of being included in MA plan networks. (22) The same is true for physicians who treat patients with higher levels of medical risk, which tracks with indications that MA plans actively seek to avoid such patients. (23) Patients in rural areas are also more likely to face restrictive networks across a number of specialties. (24)

Narrow networks compromise access to the best quality of care for the sickest individuals. Cancer care, already a nightmare to navigate for anyone regardless of their insurance, is especially bad for MA patients in terms of network inclusion. MA patients are much less likely than TM patients to be able to access cancer care at teaching hospitals, Commission on Cancer-accredited hospitals, or National Cancer Institute-designated centers. (25) MA patients are also less likely to have access to high-volume hospitals with more experience doing complex, high-risk surgery for cancers of the lung, esophagus, stomach, liver, pancreas, or rectum. This lack of access, largely a result of narrow networks as well as delays in receiving care, was found to have likely contributed to higher 30-day mortality rates for liver, pancreas, and stomach cancer surgeries. In other words, narrow networks are killing cancer patients. (26)

A final issue with MA networks is the prevalence of “ghost” networks. These networks claim to include providers who are not actually in the network, and sometimes no longer even exist. A study by the U.S. Senate Committee on Finance found that over 80% of identified listings for mental health providers in studied MA plans were inaccurate or unavailable. Of 120 provider listings who were contacted, researchers only succeeded in setting up an appointment with 22. (27)

Another study of dermatologists in MA networks found that more than half of the dermatologists listed had incorrect contact information, were deceased, retired, had moved, were not accepting new patients, did not accept the insurance plan, or were subspecialized. (28) Ghost networks present a huge transparency issue for MA beneficiaries, who may select a plan based on the appearance of a robust network only to find there are far fewer available providers than initially shown.

It is also worth noting that hospital networks in MA may be shrinking as health systems continue to opt out of accepting Medicare Advantage due to low reimbursement rates and the administrative burden of insurer practices like prior authorization. Dozens of hospitals, including large and well-known systems like Scripps Health and Mayo Clinic, have indicated that they will no longer take most or all MA plans because of these issues. (29) Patients, especially those in rural areas or places with few options for medical care, suffer greatly from these closures, which further decrease access to care for everyone in the community. (30)

Patient Narrative: Restricting Cancer Care

“In 2021, my wife became very seriously ill very suddenly, within a matter of 3 or 4 days, and she was diagnosed on the 5th or 6th day with category 4 brain cancer, glioblastoma, inoperable. Pretty much from that point in time, it was always a fight with insurance. Which hospital could we be in? Could we coordinate benefits between hospitals? Some services might only be covered in one hospital and other services in another hospital. What kind of treatment could she get approved for as she got progressively worse? Would she be able to be admitted to hospice? I wouldn’t wish it on anybody. It was absolutely horrible.” – Husband of MA patient, New York

Patient Narrative: Restrictive Networks

“Trying to find a dentist on my Blue Cross plan was virtually impossible. They were not accepting new patients, at least not when I told them I was a Medicare Advantage patient. After a lot of searching, I finally found a dentist, and now, what I have to do is take a ferry from my home, then drive about 20 miles into another town, and there is the only dentist I can go to. All of the travel combined takes about an hour to an hour and a half each way, when there are dentists who won’t accept Medicare Advantage patients ten minutes from my house.” – MA patient, Washington

Provider Narrative: Ghost Networks

“When Medicare Advantage plans were taking off in our area some years ago, Coventry Health, which later became a part of Aetna, sold a Medicare Advantage plan in the area that listed us as a network provider—but we weren’t. The first patient that showed up with this plan, I had to look it up and tell them we weren’t in-network, and they were furious, because this plan was sold to them on this presumption. This was bad enough and they sold this plan to enough people that I reported them to CMS for contracting issues, and they had to change their network.” – Primary care practice office manager, Missouri

Patient Harms: Prior Authorization

Even if patients are able to obtain an appointment, the challenges do not end there. Like other insurance plans, MA plans practice “utilization management,” requiring prior authorization (PA) for most tests, procedures, and medications. Ostensibly, the purpose of this practice is to prevent unnecessary use of medical services; in practice, it is often a way for insurers to delay paying for necessary care in the hopes that patients will abandon their efforts to receive it. By contrast, beneficiaries in Traditional Medicare are only required to obtain prior authorization for a small set of services, meaning delays in care due to denial are much rarer.

When it comes to its effect on patient care, prior authorization is almost universally hated by health care providers. A survey of physicians conducted in 2022 by the American Medical Association (AMA) found that 94% of physicians reported that PA caused delays in care for their patients, with 80% saying that this delay led to treatment abandonment at least some of the time. (31) 89% of physicians said that PA has a negative effect on patient treatment, with 25% of physicians even reporting that delays in treatment due to PA led to a patient’s hospitalization. (32) Although the AMA’s survey was about PA in general and not specific to PA in Medicare Advantage, the organization cited this data in an open letter to the Centers for Medicare and Medicaid Services (CMS) calling for the agency to crack down on the abuse of PA in the MA program. (33)

Many problems have been reported with the use of prior authorization in Medicare Advantage. According to KFF, in 2021, more than 35 million prior authorization requests were submitted to MA plans, of which about 2 million or 6% were fully or partially denied. (34) It is important to remember that these denials do not account for delays in approval, which can take weeks and still result in profound negative consequences for patients (nor do these statistics reflect the number of requests physicians never submit because of the anticipated hassle of approval). The appeal process for denied requests also demonstrates the true harm of this process: just 11% of the 2 million denied requests were appealed, but in those appeals, 82% of denials were overturned. (35) These findings were echoed in a report by the U.S. Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG), which found that from 2014-2016, just 1% of payment or service denials in Medicare Advantage Organizations (MAOs) were appealed, but 75% of appeals overturned the initial decision. (36)

In effect, these statistics suggest that denials are often entirely arbitrary, as even one attempt to question their use results in the request’s approval in the vast majority of cases. The inpatient denial rate in MA is also higher than in other programs, with a survey by the American Hospital Association (AHA) finding that 19.1% of inpatient prior authorization requests in MA were denied, compared with 15.5% for Medicaid Managed Care patients and 11.4% for commercial insurance patients. (37) Here, too, the overturn rate on appeal was high, with 69% of MA appeals resulting in a reversal of the initial decision. (38)

Indeed, studies and reporting have demonstrated some of the magnitude and characteristics of inappropriate denials in MA. Despite statutory requirements for MA to cover all the same services as TM (and consistent claims by CMS and insurers that plans do so), an HHS OIG report from 2022 found that 13% of denials in MA, close to 1 in 7, would have been approved in TM. (39) 18% of denied requests, or close to 1 in 5, met both Medicare coverage rules and MA billing rules, meaning their denial was most charitably the result of human or system error. (40) An investigation by STAT News revealed that, contrary to claims of careful review by medical experts, insurers were using unregulated AI algorithms designed to cut off care as soon as possible based on training data, without adequate regard for the individual circumstances of the patient. (41) Another STAT investigation also revealed that the insurer UnitedHealth developed secret criteria used to deny care to patients in rehabilitation care without explanation. (42)

MA beneficiaries are aware of and concerned by the excessive delays and denials of their care as a result of prior authorization. A survey by the Commonwealth Fund found that 22% of patients on MA reported delays in care due to need for approval, compared with just 13% of TM patients. (43)

Provider Narrative: Prior Authorization

“I had a patient with several chronic diseases who was very sick and had just survived major abdominal surgery, almost miraculously. In the aftermath, she desperately needed to go to acute rehab, which is the most intensive rehab – we found a facility, she liked it, her family liked it, and then her MA plan looked at the place and said ‘No, she’s healthy enough to not go to acute rehab, we won’t authorize it.’ This was after our PM&R specialist, physical therapist, and 3 MDs on our team had told her she needed acute rehab, and that it was the only thing that would keep her out of the hospital again. And this insurer, without anyone ever looking at her, rejected that conclusion. And we knew that on Traditional Medicare this never would’ve happened.” – Internal medicine resident, Illinois

Patient Harms: Limited Coverage

Besides delaying and denying care through prior authorization, MA plans also explicitly restrict care ahead of time via the use of limits on benefits and coverage. These restrictions may, for example, set an upper bound on the number of days a patient can be admitted for an inpatient treatment, or determine what drugs will be included on a formulary.

Medicare Advantage insurers are known for aggressively advertising “supplemental benefits” such as dental, vision, and hearing. These benefits are not covered by Traditional Medicare, and thus patients on TM generally require supplemental coverage to access these services. An analysis of MA television ads found that 92% mentioned supplemental benefits as a perk of the plans, compared with just 22% touting better access to physicians. (44) What these ads fail to describe are the significant limits applied to these benefits.

59% of enrollees in an MA plan with dental coverage have a maximum benefit of $1,000 or less, beyond which any dental services will not be covered. (45) This is despite the fact that 19% of Medicare beneficiaries have reported spending more than $1,000 on dental care in out-of-pocket costs during a yearlong period. (46) Hearing services in MA are similarly restricted, as 91% of beneficiaries with hearing coverage face limits on the number of hearing aids they can receive in a given time period. (47) 32% of beneficiaries with hearing coverage have both frequency limits and a dollar limit applied to their benefit. (48) The average dollar limit for hearing coverage is $960, despite the fact that an average pair of prescription hearing aids costs over $4,000. (49) The dollar limits for vision coverage in MA are perhaps the most striking; 99% of beneficiaries receiving vision benefits have a dollar limit on coverage, and the average limit is just $160 per year. (50)

Similar coverage restrictions are present in other aspects of care as well. About 60% of MA enrollees are in plans that do not cover out-of-network outpatient mental health or substance use disorder services, with a similar number of enrollees in plans that do not cover out-of-network mental health hospitalization or opioid treatment programs. (51) A study of prescription drug coverage among 4 large MA insurers found that of the 20 most common physician-administered drugs, 17 were subject to prior authorization and 10 were subject to step therapy by at least 1 insurer (step therapy refers to a practice wherein insurers require the use of alternative treatments, and only approve the requested treatment if those prove unsuccessful). (52)

Over the period from 2018 to 2020, many of these drugs were also removed from all 4 MA- Part D (MA-PD) insurer formularies, meaning they would no longer be covered at all. Humana, for example, covered 14 of the 20 listed drugs on its Part D formulary in 2018, but by 2020 only included 4 of them. (53)

Patient Narrative: Limited Coverage

“My grandfather, who has pancreatic cancer, has to pay thousands of dollars before he gets any real coverage. On top of that, he has copays and coinsurance he needs to pay as well. He even has had to pay out-of-pocket fees for emergency life flights he needed due to complications from his chemotherapy. I know those would’ve been covered fully under Traditional Medicare.” – Grandson of MA patient, Pennsylvania

Patient Harms: Excessive Costs

Even with insurance, cost-sharing for medical services is virtually unavoidable in the United States. Traditional Medicare, for all its benefits, generally covers only 80% of the cost for outpatient services, leaving patients responsible for the other 20% (usually covered by a Medigap plan). (54) However, cost-sharing in Medicare Advantage plans is often egregious, and can lead to serious affordability issues for beneficiaries.

In a survey conducted by the Commonwealth Fund, 22% of seniors on MA reported high health care costs in the previous year, compared with 13% of seniors on TM with a Medigap supplement. (55) 41% of MA enrollees said they had problems accessing care because of high costs, compared with 35% of those in Traditional Medicare plus Medigap. Finally, 21% of those on MA reported problems paying off medical bills or debt, compared to 14% of those on TM plus Medigap. (56) Another survey from KFF found that across white, Hispanic, and Black racial groups, higher percentages of beneficiaries reported cost-related problems in MA compared to TM with a Medigap supplement. The biggest difference was among Black beneficiaries; 32% reported cost-related problems on MA, while just 20% reported the same on TM with Medigap. (57) These gaps increased for beneficiaries reported to be in fair or poor health, lending more credence to the idea that MA is especially bad for those actively dealing with significant health issues. (58)

Patient Narrative: Excessive Costs

“Like a lot of people, I thought Medicare Advantage was cheaper, and it’s supposed to cover everything Medicare covers, right? That’s the way it’s supposed to work. I made the mistake of choosing a UnitedHealth MA plan, and it was about a year later I realized what kind of hell I was in when I ended up inpatient. I was looking at $300+ dollars a night bills for being inpatient. And because of my health issues, I was ending up in the hospital nearly every six weeks, staying for a few days to a week and then coming out with these monstrous bills. As long as you’re not sick, Medicare Advantage is great – you’re spending less money! But when you do get sick, the co-pays, the co-insurance, out of pocket costs, they grow so fast, and you never hit the deductible.” – MA patient, New Hampshire

Patient Harms: Trapped in MA

One of the promises of free-market advocates in health care is the idea of “consumer choice.” The insurance industry will claim that the availability of a wide variety of plans allows beneficiaries to find one that suits their personal needs, and encourages competition among insurers that leads to better policies. However, this narrative elides the serious problems MA enrollees face in leaving the program if they find it unsuitable.

There is substantial evidence that many patients, especially those who are more ill or face high medical costs, tend to leave MA at high rates. A report by the Government Accountability Office (GAO) found that Medicare beneficiaries in their last year of life (when medical costs are generally very high) disenroll from MA back to TM at more than twice the rate of all other beneficiaries. (59) A similar study in Health Affairs found that the switching rates from MA to TM were generally higher than rates for the reverse among patients receiving high-cost services like long-term nursing home care (17% vs 3%), short-term nursing home care (9% vs 4%), and home health care (8% vs 3%). (60)

Not all enrollees have the option of leaving MA when things go wrong, though. When beneficiaries first become eligible for Medicare, they have the option of signing up for MA or TM. For their first six months of eligibility, these beneficiaries are protected by “guaranteed issue” requirements for supplemental Medigap plans. This means that Medigap insurers are not allowed to deny any senior a Medigap policy, nor can they engage in “medical underwriting” to potentially charge a higher premium based on health history or other factors. (61) This six month period is extended to twelve months when a beneficiary joins MA.

However, once this period is up, these protections disappear in all but four states. If an enrollee outside of these states signs up for MA during their initial open enrollment period, and then decides to switch to TM during the next year’s open enrollment period, they are no longer guaranteed to receive a Medigap policy, and can be denied on the basis of their medical history. Many seniors are unable to afford the 20% of costs covered by Medigap, meaning their only option is to stick with MA, even if they are unhappy with their coverage. (62) While more states do require “community rating,” wherein insurers must charge all recipients of a Medigap plan the same premiums, these protections mean little to those who are outright denied coverage to begin with. (63) Thus, MA plans get to keep many of their customers not on the basis of their high- quality services, but because they simply have nowhere else to go.

Patient Narrative: Trapped in MA

“If my husband gets older and develops more serious problems, his access to a specialist may be restricted under his MA plan. So we would like to pull him out and get him on Traditional Medicare, and my worry is that now he’s being upcoded, he has a high risk health profile, so how much is Medigap going to cost if we can get it? Who knows about these kinds of problems until later on?” – Wife of MA patient, North Carolina

Provider Harms: Barriers to Patient Care and Administrative Burden

Thus far, we have discussed the myriad harms that MA inflicts upon patients. It is worth remembering, however, that MA is not only a problem for them. Medicare Advantage makes the jobs of physicians and health care workers substantially more difficult, contributing to stress, burnout, and moral injury, which refers to the psychological impacts of working in a system that forces providers to compromise their ethical commitment to patients due to the profit-driven nature of the health care system. (64)

As discussed earlier, limited networks and prior authorization are two techniques used by MA insurers to deprive patients of care as a means of saving money. Physicians are forced to contend with these practices daily, greatly hampering their ability to adequately care for patients. Limitations in networks mean that physicians often cannot refer patients to their preferred specialist or one that is convenient to the patient, making it harder to follow through on treatment plans and increasing the odds that patients will abandon treatment. These failures in treatment can weigh heavily on physicians, especially when they result in harm to a patient’s health.

Even if patients are able to get an appointment and receive a diagnosis, the physician will often need to spend hours wrestling with the insurer to justify their desired course of action and receive prior authorization for it. These interactions can be highly frustrating; in the previously mentioned survey by the AMA, 31% of physicians reported that PA criteria rarely or never follow evidence-based guidelines approved by medical specialty societies. (65) In other words, many physicians believe that insurers are denying care based on faulty premises, rejecting the expertise of these physicians and established national guidelines in favor of their own dubious standards.

The administrative burdens of prior authorization are significant. 88% of physicians describe the burden of PA as high or extremely high. (66) 35% of physicians surveyed reported that they have needed to hire staff members to work exclusively on prior authorization. (67)

In a survey of practices conducted by the Medical Group Management Association (MGMA), groups were asked to name the type of policy most burdensome for obtaining prior authorization: 46% of groups said Medicare Advantage, compared with 32% naming commercial plans and just 4% naming Traditional Medicare. (68) 84% of practices also reported that PA requirements for MA had increased in the last 12 months. (69) When asked if the clinician hired by the insurer to review an authorization held relevant expertise to the treatment in question, 72% of groups said they did not. (70) And perhaps most strikingly, an overwhelming 97% of practices said their patients had experienced delays and denials of necessary care due to prior authorization. (71)

The AMA’s physician survey found that practices spend an average of 14 hours each week processing 45 prior authorization requests, for a mean time of about 19 minutes per request. (72) Taking this figure as a global average (keeping in mind that practices rate prior authorization in MA as more burdensome than other types), the 35 million requests KFF reported were made in 2021 would result in roughly 11.1 million hours spent just on prior authorization for Medicare Advantage. Using a higher reported average time of 35 minutes per request from the MGMA survey, this number increases to 20.5 million hours. That is just over 1200 years at a minimum, and over 2300 years at maximum–or, in health care terms, anywhere from 35 to 65 million average patient visits. (73)

Prior authorization is not the only aspect of MA that results in administrative burden to physicians. In another survey from the MGMA, roughly 86% of medical group practices reported MA chart audits as being at least moderately burdensome to the practice, with 62% reporting that audits were very or extremely burdensome. (74) Because these chart audits are often used by MA insurers to inappropriately extract more money from the Medicare fund via upcoding, this also means that physicians are incurring a significant time and resource burden for the financial benefit of insurers. This is yet another example of MA contributing to moral injury among physicians. (75)

Provider Narrative: Barriers to Patient Care

“We had a patient recommended for acute rehab. He was medically ready, but insurance denied him. We had to do an appeal, and we’re waiting on the results of the appeal, but he’s been here for 20 days, and 10 of those days have been us fighting with the insurance. In that time he’s developed pneumonia.” – Nurse and case manager, Illinois

Provider Narrative: Administrative Burden

“In one month, the staff for our two oncologists did 360 prior authorizations for their patient population–so much so that I’ve had to add another full-time equivalent employee just to do prior authorizations in the oncology unit. And every request in there is urgent.” – CEO of health system, Connecticut

Provider Harms: Corporatization of Medicine

In a general sense, physicians are increasingly under the thumb of large corporations or other entities that interfere with the practice of medicine. Approximately 74% of physicians are now employed by a hospital, health system, health insurer, private equity firm, or other corporate entity. Over a three year period from 2019-2021, the percentage of corporate-owned medical practices increased an astonishing 39%. (76) In 30% of metropolitan statistical areas (MSAs) in the United States, one private equity firm owned more than 30% of physician practices in a given specialty; in 13% of MSAs, one private equity firm owned more than 50% of practices. (77)

One significant motive for this rapid increase in corporate control of medicine is the massive profit machine that is Medicare Advantage. (78) Health insurers and private equity groups seek to control providers, encouraging them to upcode diagnoses and carefully managing the amount of care that their employees are allowed to give to beneficiaries. In one reported instance, the combined health system and insurer Kaiser Permanente called physicians during lunch breaks and after work to ask them to add more diagnoses to the charts of their patients, even offering bonuses and bottles of champagne as a reward for doing so. (79)

Another method of compelling doctors to participate in the financialization of care is through the use of “full-risk” or “global risk” models, in which physicians assume the financial risk of caring for patients and only make money if they can stay under a certain budget. MA plans have increasingly adopted such models in contracts with physician groups and health systems, leading some to fear that doctors will have to decide between providing the necessary amount of care for a patient, or meeting their budget in order to stay afloat. (80)

By placing financial concerns in the hands of physicians, MA plans subject them to moral injury. To consider profit in the determination of a patient’s care goes against the most important ethical standards that health care providers set for themselves; however, the reality is that physicians in the United States must already do this as a result of the constraints placed upon them by insurers like those in Medicare Advantage. When a physician has to prescribe a less effective medication because it is the only one covered by the patient’s plan, or when a patient must wait 3 months for a surgery that will allow them to walk without pain, profit motives have already infected the standard of care. The overt corporatization of medicine and the placing of financial incentives explicitly into the hands of physicians are simply the next logical steps in this process.

Provider Narrative: Corporatization of Medicine

“My patient was told by an MA plan that they would no longer cover a particular calcium channel blocker, and that the patient needed to be on a different one. The cost difference here could not have been significant, but they switched the coverage, and encouraged the patient to get their drugs by mail. In the wake of all this shuffling around without my involvement, the patient got confused, and was taking both medications. They came in profoundly hypotensive, and we had to keep them on IV fluids all day to avoid a hospitalization. All this came from the effort of trying to pinch a penny, but what I really noticed was this was a pulling apart of what is most important in medicine – the doctor-patient relationship, and the pharmacist-patient relationship. It was all about the dollar.” – Primary care physician, South Carolina

Conclusion

Medicare Advantage represents the worst of private insurance coming to take over the best system of health care that America has to offer. Insurers in MA prey on some of the most vulnerable among us, luring them in with false promises of superior coverage and low costs only to make every effort possible to prevent them from accessing necessary health care, all while siphoning billions of dollars from taxpayers. The more MA is allowed to expand, the more harm will come to patients, physicians, hospitals, and the health care system writ large. More patients will die waiting for care to be approved, more doctors will face tremendous burdens trying to prevent this outcome, and more hospitals in areas of critical need will close as MA plans refuse to pay for their services.

The money that goes to profit-driven insurers in MA should instead be used to improve Traditional Medicare, including by adding dental, vision, and hearing coverage as well as establishing an out-of-pocket spending cap. Traditional Medicare follows the original spirit of the program, one that was created to serve all Americans without the perverse incentives that come from a profit motive. This is the model we should be following in our health system, instead of devoting more dollars to the failed experiments of managed care. We must eliminate out-of-control profit seeking in Medicare and beyond, both by reining in the abuses of insurers via executive action and legislation, and by greatly expanding our public health insurance programs. It’s time to take Medicare back for the people.

Endnotes

  1. PNHP, “Our Payments, Their Profits,” October 2023, https://pnhp.org/system/assets/uploads/2024/01/MAOverpaymentReport_Oct2023.pdf.
  2. MedPAC, “Report to the Congress: Medicare Payment Policy,” March 2023, https://www.medpac.gov/wp-content/uploads/2023/03/Mar23_MedPAC_Report_To_Congress_SEC.pdf, 367.
  3. Ibid., 366.
  4. Ibid.
  5. Elizabeth Warren et al., “Letter to Admin Brooks-LaSure Re: MA Data,” December 7, 2023, https://www.warren.senate.gov/imo/media/doc/2023.12.07%20Letter%20to%20Admin.%20Brooks-LaSure%20re%20MA%20Data.pdf.
  6. Gretchen Jacobson et al., “The Private Plan Pitch: Seniors’ Experiences with Medicare Marketing and Advertising,” Commonwealth Fund, September 12, 2023, https://www.commonwealthfund.org/publications/issue-briefs/2023/sep/private-plan-pitch-seniors-experiences-medicare-marketing-advertising.
  7. Chris Sommerfeldt, “Retired NYC workers sue to block Mayor Adams’ latest Medicare Advantage Plan,” New York Daily News, May 31, 2023, https://www.nydailynews.com/2023/05/31/retired-nyc-workers-sue-to-block-mayor-adams-latest-medicare-advantage-plan-exclusive/.
  8. Nancy Ochieng and Gabrielle Clerveau, “How Many Physicians Have Opted Out of the Medicare Program?” KFF, September 11, 2023, https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/.
  9. Meredith Freed et al., “Medicare Advantage 2024 Spotlight: First Look,” KFF, November 15, 2023, https://www.kff.org/medicare/issue-brief/medicare-advantage-2024-spotlight-first-look/.
  10. “Medicare Data Hub: Medicare Advantage,” Commonwealth Fund, https://www.commonwealthfund.org/medicare-data-hub/medicare-advantage.
  11. Andréa Elizabeth Caballero et al., “Are Limited Networks What We Hope And Think They Are?” Health Affairs, February 12, 2018, https://www.healthaffairs.org/content/forefront/limited-networks-we-hope-and-think-they.
  12. Laura Skopec et al., “Why Do Medicare Advantage Plans Have Narrow Networks?” Urban Institute, November 2018, https://www.urban.org/sites/default/files/publication/99414/why_do_medicare_advantage_plans_have_narrow_networks.pdf, 5.
  13. Ibid., 5-7.
  14. Laura Skopec and Robert A. Berenson, “The Medicare Advantage Quality Bonus Program: High Cost for Uncertain Gain,” Urban Institute, June 26, 2023, https://www.urban.org/research/publication/medicare-advantage-quality-bonus-program.
  15. Gretchen Jacobson et al., “Medicare Advantage: How Robust Are Plans’ Physician Networks?” KFF, October 5, 2017, https://www.kff.org/medicare/report/medicare-advantage-how-robust-are-plans-physician-networks/.
  16. Ibid.
  17. Gretchen Jacobson et al., “Medicare Advantage Hospital Networks: How Much Do They Vary?” KFF, June 20, 2016, https://www.kff.org/medicare/report/medicare-advantage-hospital-networks-how-much-do-they-vary/.
  18. Eric Krupa, “Voices of Medicare: Medicare Advantage Network Inadequacy,” Center for Medicare Advocacy, https://medicareadvocacy.org/voices-of-medicare-medicare-advantage-network-inadequacy/.
  19. Jane M. Zhu et al., “Psychiatrist Networks In Medicare Advantage Plans Are Substantially Narrower Than In Medicaid And ACA Markets,” Health Affairs, July 2023, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2022.01547?journalCode=hlthaff.
  20. Jacobson et al., “Medicare Advantage Hospital Networks,” https://www.kff.org/medicare/report/medicare-advantage-how-robust-are-plans-physician-networks/.
  21. Ibid.
  22. Jung Ho Gong et al., “Proportion of Physicians Who Treat Patients With Greater Social and Clinical Risk and Physician Inclusion in Medicare Advantage Networks,” JAMA Health Forum, July 21, 2023, https://jamanetwork.com/journals/jama-health-forum/fullarticle/2807454.
  23. Ibid.
  24. Yevgeniy Feyman et al., “Restrictiveness of Medicare Advantage provider networks across physician specialties,” Health Services Research, April 9, 2024, https://pubmed.ncbi.nlm.nih.gov/38594081/.
  25. Mustafa Raoof et al., “Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients,” Journal of Clinical Oncology, November 10, 2022, https://ascopubs.org/doi/full/10.1200/JCO.21.01359.
  26. Ibid.
  27. Senate Committee on Finance, “Medicare Advantage Plan Directories Haunted by Ghost Networks,” May 3, 2023, https://www.finance.senate.gov/imo/media/doc/050323%20Ghost%20Network%20Hearing%20-%20Secret%20Shopper%20Study%20Report.pdf, 3.
  28. Jack S. Resneck Jr. et al., “The accuracy of dermatology network physician directories posted by Medicare Advantage health plans in an era of narrow networks,” JAMA Dermatology, December 2014, https://pubmed.ncbi.nlm.nih.gov/25354035/.
  29. Claire Wallace, “8 health systems calling it quits with Medicare Advantage: What ASCs should know,” Becker’s ASC Review, September 26, 2023, https://www.beckersasc.com/asc-coding-billing-and-collections/8-health-systems-calling-it-quits-with-medicare-advantage-what-ascs-should-know.html.
  30. Sarah Jane Tribble, “Tiny, Rural Hospitals Feel the Pinch as Medicare Advantage Plans Grow,” KFF Health News, October 23, 2023, https://kffhealthnews.org/news/article/medicare-advantage-rural-hospitals-financial-pinch/.
  31. American Medical Association, “2022 AMA prior authorization (PA) physician survey,” https://www.ama-assn.org/system/files/prior-authorization-survey.pdf.
  32. Ibid.
  33. American Medical Association et al., “Open Letter to Chiquita-Brooks LaSure,” February 13,  2023, https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2FPA-sign-on-letter-Part-C-and-D-rule.zip%2FPA-sign-on-letter-Part-C-and-D-rule.pdf.
  34. Jeannie Fugelsten Biniek and Nolan Sroczynski, “Over 35 Million Prior Authorization Requests Were Submitted to Medicare Advantage Plans in 2021,” KFF, February 2, 2023, https://www.kff.org/medicare/issue-brief/over-35-million-prior-authorization-requests-were-submitted-to-medicare-advantage-plans-in-2021/.
  35. Ibid.
  36. U.S. Department of Health and Human Services Office of Inspector General, “Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials,” September 2018, https://oig.hhs.gov/oei/reports/oei-09-16-00410.pdf.
  37. American Hospital Association, “Addressing Commercial Health Plan Challenges to Ensure Fair Coverage for Patients and Providers,” November 2022, https://www.aha.org/system/files/media/file/2022/10/Addressing-Commercial-Health-Plan-Challenges-to-Ensure-Fair-Coverage-for-Patients-and-Providers.pdf, 12.
  38. Ibid.
  39. U.S. Department of Health and Human Services Office of Inspector General, “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care,” April 2022, https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf.
  40. Ibid.
  41. Casey Ross and Bob Herman, “Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need,” STAT News, March 13, 2023, https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/.
  42. Bob Herman and Casey Ross, “UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients,” STAT News, December 28, 2023, https://www.statnews.com/2023/12/28/medicare-advantage-united-health-navihealth-rehab-care-restrictions/.
  43. Gretchen Jacobson et al., “What Do Medicare Beneficiaries Value About Their Coverage?” Commonwealth Fund, February 22, 2024, https://www.commonwealthfund.org/publications/surveys/2024/feb/what-do-medicare-beneficiaries-value-about-their-coverage.
  44. Jeannie Fuglesten Biniek et al., “How Health Insurers and Brokers Are Marketing Medicare,” KFF, September 20, 2023, https://www.kff.org/report-section/how-health-insurers-and-brokers-are-marketing-medicare-report/#miss-out-on-benefits.
  45. Meredith Freed et al., “Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage,” KFF, September 12, 2021, https://www.kff.org/health-costs/issue-brief/dental-hearing-and-vision-costs-and-coverage-among-medicare-beneficiaries-in-traditional-medicare-and-medicare-advantage/.
  46. Meredith Freed et al., “Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries,” KFF, March 13, 2019, https://www.kff.org/medicare/issue-brief/drilling-down-on-dental-coverage-and-costs-for-medicare-beneficiaries/.
  47. Meredith Freed et al., “Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage.”
  48. Ibid.
  49. Tom Horton, “How much do hearing aids cost?” CBS News, April 26, 2024, https://www.cbsnews.com/essentials/how-much-do-hearing-aids-cost/.
  50. Ibid.
  51. Meredith Freed et al., “Mental Health and Substance Use Disorder Coverage in Medicare Advantage Plans,” KFF, April 28, 2023, https://www.kff.org/mental-health/issue-brief/mental-health-and-substance-use-disorder-coverage-in-medicare-advantage-plans/.
  52. Kelly E. Anderson and G. Caleb Alexander, “Medicare Advantage Coverage Restrictions for the Costliest Physician-Administered Drugs,” American Journal of Managed Care, July 12, 2022, https://www.ajmc.com/view/medicare-advantage-coverage-restrictions-for-the-costliest-physician-administered-drugs.
  53. Ibid.
  54. Center for Medicare Advocacy, “Part B,” https://medicareadvocacy.org/medicare-info/medicare-part-b/.
  55. Faith Leonard et al., “Medicare’s Affordability Problem: A Look at the Cost Burdens Faced by Older Enrollees,” Commonwealth Fund, September 19, 2023, https://www.commonwealthfund.org/publications/issue-briefs/2023/sep/medicare-affordability-problem-cost-burdens-biennial.
  56. Ibid.
  57. Jeannie Fuglesten Biniek et al., “Cost-Related Problems Are Less Common Among Beneficiaries in Traditional Medicare Than in Medicare Advantage, Mainly Due to Supplemental Coverage,” KFF, June 25, 2021, https://www.kff.org/medicare/issue-brief/cost-related-problems-are-less-common-among-beneficiaries-in-traditional-medicare-than-in-medicare-advantage-mainly-due-to-supplemental-coverage/.
  58. Ibid.
  59. Government Accountability Office, “Beneficiary Disenrollments to Fee-for-Service in Last Year of Life Increase Medicare Spending,” June 2021, https://www.gao.gov/assets/gao-21-482.pdf.
  60. Momotazur Rahman et al., “High-Cost Patients Had Substantial Rates Of Leaving Medicare Advantage And Joining Traditional Medicare,” Health Affairs, October 2015, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2015.0272?journalCode=hlthaff.
  61. Centers for Medicare and Medicaid Services, “Get ready to buy,” https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy.
  62. Sarah Jane Tribble, “Older Americans Say They Feel Trapped in Medicare Advantage Plans,” KFF Health News, January 5, 2024, https://kffhealthnews.org/news/article/medicare-advantage-medigap-enrollment-trap-switch-preexisting-conditions/.
  63. Cristina Boccuti et al., “Medigap Enrollment and Consumer Protections Vary Across States,” KFF, July 11, 2018, https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/.
  64. Simon G. Talbot and Wendy Dean, “Physicians aren’t ‘burning out.’ They’re suffering from moral injury,” STAT News, July 16, 2018, https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/.
  65. American Medical Association, “2022 prior authorization physician survey.”
  66. Ibid.
  67. Ibid.
  68. Medical Group Management Association, “Spotlight: Prior Authorization in Medicare Advantage,” May 2023, https://www.mgma.com/getkaiasset/fa2103f5-a2f6-47a1-b467-4748b5007c7e/05.03.2023_PA-in-MA_FINAL.pdf, 2.
  69. Ibid.
  70. Ibid., 5.
  71. Ibid.
  72. American Medical Association, “2022 prior authorization physician survey.”
  73. Hannah T. Neprash, et al., “Association of Primary Care Visit Length With Potentially Inappropriate Prescribing,” JAMA Health Forum, March 10, 2023, https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802144#:~:text=The%20median%20physician%20in%20the,or%20less%20with%20their%20patients.
  74. Medical Group Management Association, “Annual Regulatory Burden Report,” November 2023, https://www.mgma.com/getkaiasset/423e0368-b834-467c-a6c3-53f4d759a490/2023%20MGMA%20Regulatory%20Burden%20Report%20FINAL.pdf, 5.
  75. Reed Abelson and Margot Sanger-Katz, “‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions,” New York Times, October 8, 2022, https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html.
  76. Physicians Advocacy Institute, “Physician Employment and Acquisitions of Physician Practices 2019-2021 Specialties Edition,” June 2022, https://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/PAI-Research/Physician%20Practice%20Trends%20Specialty%20Report%202019-2022.pdf?ver=MWjYUAcARbuGP9uxcgQkPw%3d%3d, 5.
  77. Richard M. Sheffler et al., “Monetizing Medicine: Private Equity and Competition in Physician Practice Markets,” American Antitrust Institute, July 10, 2023, https://www.antitrustinstitute.org/wp-content/uploads/2023/07/AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf, 4.
  78. Reed Abelson, “Corporate Giants Buy Up Primary Care Practices at Rapid Pace,” New York Times, May 12, 2023, https://www.nytimes.com/2023/05/08/health/primary-care-doctors-consolidation.html.
  79. Reed Abelson and Margot Sanger-Katz, “The Cash Monster was Insatiable.”
  80. Phil Galewitz, “Medicare Advantage plans shift their financial risk to doctors,” Modern Healthcare, October 8, 2018, https://www.modernhealthcare.com/article/20181008/NEWS/181009920/medicare-advantage-plans-shift-their-financial-risk-to-doctors.

Recommended Citation

Physicians for a National Health Program, “Taking Advantage: How Corporate Health Insurers Harm America’s Seniors,” May 23, 2024, https://pnhp.org/harmsreport.

Acknowledgements

Physicians for a National Health Program (PNHP) is grateful to the following individuals and organizations for their feedback and support. Without them, this report would not be possible:

  • ASO Communications
  • Diane Archer, Just Care USA
  • Gretchen Jacobson, The Commonwealth Fund
  • James G. Kahn, M.D., M.P.H.,University of California, San Francisco
  • Eagan Kemp, Public Citizen
  • David Lipschutz, Center for Medicare Advocacy
  • Dhyan Wolf, Video Editor

We also wish to thank the dozens of patients, family members, physicians, allied health professionals, and Medicare supporters who shared their stories with us. Interview excerpts that appear in this report have been edited for clarity.

The PNHP Policy Committee worked closely with Communications Specialist Gaurav Kalwani to author this report. The committee consists of: Donald Bourne, M.D./Ph.D. 2027; Stephen Kemble, M.D.; Mark Krasnoff, M.D.; Susan Rogers, M.D.; Kip Sullivan, J.D.; Kay Tillow; James Patrick Waters, MS4; and Ed Weisbart, M.D.

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