Cassidy in the Capitol on June 4. Photo: Allison Robbert / Bloomberg via Getty Images
A bid to address insurer overbilling in Medicare Advantage through the reconciliation bill is facing skepticism from some Senate Republicans as they work to wrap up policy changes in the package.
Why it matters: The No UPCODE Act from Sens. Bill Cassidy and Jeff Merkley would crack down on instances in which MA plans make beneficiaries appear sicker than they may be to receive a higher Medicare reimbursement.
- It could save $124 billion over a decade but be politically toxic if it's seen as cutting Medicare.
What they're saying: Cassidy touted the bill's bipartisan support this week and said he was still working to build consensus for including it in reconciliation.
- "Jeff Merkley, over the weekend, totally owned it. He said, 'This is a good bill. It's bipartisan,'" Cassidy said. "It doesn't cut benefits. It preserves money for the hospital trust fund. It is a good bill."
- "It is waste, fraud and abuse, the personification of," he added.
But on the other side, Sen. Josh Hawley said Tuesday that he was "pretty skeptical of doing anything on Medicare in reconciliation."
- Hawley said that he spoke with President Trump on Tuesday and that Trump had said, "I don't want to see you guys touch Medicare, Medicaid, Social Security."
- Sen. Kevin Cramer reiterated that "everyone's a little afraid of these tougher conversations" on Medicare, adding that he wasn't sure whether there was a path forward for the proposal in reconciliation.
Although such MA changes were off limits in the House's reconciliation bill, Energy and Commerce Chair Brett Guthrie signaled support for the policy when asked about it at a Politico event Tuesday.
- "We're certainly open to it," said Guthrie, who added that there were some "real questions" on the issue of insurers upcoding to get bigger payouts and that the House wants to look into the practice.
- But he added that the House really focused on Medicaid because "if we brought in Medicare at the same time," negotiations would have been more difficult.
Zoom in: MA and insurer industry groups have quickly mobilized against the bill.
- The Better Medicare Alliance, a Medicare Advantage advocacy group, shared polling with GOP lawmakers showing that voters could view changing the MA payment system as a cut.
- AHIP also put out a statement this week in opposition to the Cassidy-Merkley bill, saying it would result in cuts to benefits for seniors.
Yes, but: Sen. Mike Rounds said that even if the proposal doesn't get folded into reconciliation, he sees a path forward later, possibly working in tandem with the chamber's Democrats.
- "It's been discussed within our meetings, and I have had nobody that has disagreed with it yet," Rounds said. "I think it's pretty broadly accepted. I've even talked to some of my Democrat colleagues about it and they say 'Well, of course that should be fixed.'"
Peter Sullivan contributed to this story.
