I helped create Medicare Advantage. Here's why I believe it needs reform.

The Hill

20 hours ago

In 2003, I helped write the Medicare Modernization Act, which established Medicare Advantage and added a prescription drug benefit through Part D. At the time, I believed that introducing private-sector competition would spur innovation, improve care for seniors and save taxpayer dollars. I was encouraged by health insurance executives, who asked me to be a champion for Medicare Advantage — and I agreed. I believed in the promise of a system where public-private partnership could deliver better results for beneficiaries.
More than 20 years later, I have to admit: the program no longer lives up to that promise.
Medicare Advantage has become something quite different from what many of us envisioned. Instead of a vibrant alternative that drives efficiency and delivers value, it has evolved into a system dominated by a handful of massive insurers who are gaming the rules for profit. These companies are not small innovators fighting to offer better care — they are corporate behemoths raking in billions by exploiting a program meant to better serve our seniors.
Overpayments and risk-score manipulation have become endemic. The program's original safeguards against excessive billing and cherry-picking enrollees have proven too weak in the face of powerful lobbying, limited oversight, and manipulative practices that seemingly stay just within the rules. The result is that taxpayers are spending more per beneficiary in Medicare Advantage than they would in traditional Medicare — all while beneficiaries often face narrower networks, opaque denials and delays in getting care.
It pains me to say this, but the system we helped create is being abused. And it's not just hurting taxpayers. It's hurting patients. Seniors who enrolled in Medicare Advantage plans expecting better care are too often finding out — at the worst possible time — that their plan won't cover what they need, or that they've been shuffled into narrow networks without real choice.
This is not what we intended.
To be clear, I still believe that private-sector participation can play a meaningful role in Medicare. But it must be subject to accountability, transparency and real competition. Today's Medicare Advantage market lacks all three. A handful of insurers control most of the market. Star ratings are gamed. Audits are rare. And efforts to claw back overpayments are fought tooth and nail.
We owe it to America's seniors — and to taxpayers and the sustainability of Medicare itself — to reform this system. That means restoring parity between traditional Medicare and Medicare Advantage, enforcing robust oversight, and ending the perverse incentives that reward insurers for risk coding games rather than real care improvements and innovations.
It also means resisting the industry's scare tactics. Every time reform is proposed, insurers trot out fear-driven campaigns suggesting that seniors will lose their benefits. But what seniors truly need is a Medicare program — whether traditional or Advantage — that works for them, not for corporate shareholders.
I was proud to support the Medicare Modernization Act. But I never imagined that Medicare Advantage would become a vehicle for such waste and abuse. It's time to fix it and restore the program's true promise as a competitive marketplace that provides seniors innovative alternative plans — before the entire foundation of Medicare is eroded beyond repair.
Jim Greenwood served in Congress from 1993-2005.