FOR IMMEDIATE RELEASE: May 29, 2024
Media Contact: Gaurav Kalwani, PNHP Policy & Communications Specialist, gaurav@pnhp.org
On Thursday, May 23, Physicians for a National Health Program (PNHP) released a new report detailing the ways insurers in the Medicare Advantage (MA) program are causing serious harm to patients, doctors, and hospitals. The report, which cites dozens of studies as well as original interviews conducted with patients and health care workers across the country, shows that the results of allowing private insurers to infiltrate Medicare have been disastrous for millions of seniors and people with disabilities.
Research shows that patients in MA plans must deal with narrow networks that significantly restrict their access to physicians and hospitals. Close to 12 million MA beneficiaries are in a plan that excludes more than 70% of physicians in their county. Many cancer patients in MA lack access to the best hospitals and doctors for treatment, in some cases leading to a twofold increase in risk of death following surgery. Patients are also often misled about the availability of physicians through so-called “ghost networks,” directories that contain inaccurate information showing far more in-network physicians than actually exist.
Under MA plans, patients must seek prior authorization for many routine tests, treatments, and other procedures ordered by their doctor—often waiting days or weeks, only to be denied approval for necessary care. The authorization process also takes up an astonishing amount of time and resources for health care workers, with medical practices spending anywhere from 11.1 to 20.5 million hours per year just on prior authorization for MA patients. In one interview featured in the report, a hospital executive stated that his oncology unit with only 2 doctors had to perform 360 prior authorization requests in just one month.
Patients in interviews also described paying thousands of dollars out of pocket for care due to high deductibles, limited coverage (especially for serious and chronic illnesses), and excessive cost-sharing. This fits with data showing that more than 7 million beneficiaries in MA can be described as underinsured based on high health care costs. Insurers similarly refuse to pay doctors and hospitals for care, leading to serious financial problems for institutions that are often already stretched thin, especially in rural and underserved areas. These issues and more are analyzed further in the report.
“Any doctor who works with patients on Medicare Advantage will tell you how heavily it compromises our ability to provide needed care,” said PNHP Vice President and gynecologic oncologist Dr. Diljeet Singh. “The only advantage this program provides is to the insurance corporations that run it. Patients suffer from delays and denials of care, and physicians waste time and energy fighting to get treatments approved, all so insurers can pad their already outrageous profits. This report proves that we must stop the profiteering in Medicare before corporate insurers take over the program entirely.”
Physicians for a National Health Program (pnhp.org) is a nonprofit research and education organization whose more than 25,000 members support single-payer Medicare for All reform.