Rolling Back Medicare Advantage by Robert Kuttner

[justaprogressive]

Connecticut public employees have just won a major victory over Medicare Advantage, the brand name for private-insurer HMO products for seniors. In 2017, in order to save money, Connecticut shifted all state retirees, some 65,000 of them, to Medicare Advantage and denied them the freedom to stay on traditional public Medicare. But now, thanks to rank-and-file protest and organizing, that policy has just been reversed.

A number of insurance companies sponsor Medicare Advantage plans. They have been criticized for using a variety of strategies to maximize profits by stinting on care, including heavy-handed case management, limiting choice of providers, and target-marketing to relatively healthy seniors with gimmicks such as health clubs, thus fragmenting the risk pool.

Worse, lobbying by insurers has led to a formula in which traditional Medicare payers subsidize these private Medicare Advantage plans to the tune of $82 billion over ten years, giving them an artificial price advantage. The plans appear to be great deals—until you get seriously ill.

One Connecticut retiree who was switched to a Medicare Advantage plan, James Russell, a former professor of sociology at Eastern Connecticut State University, did become seriously ill. In 2021, he was diagnosed with a rare form of lung cancer. His preferred hospital, MD Anderson in Texas, was in the network of United Healthcare, the operator of Russell’s Medicare Advantage plan.

https://prospect.org/2026/05/13/rolling-back-medicare-advantage/]