Republicans have discovered $124 billion in wasteful Medicare spending that enriches insurance coverage firms on the expense of seniors and taxpayers. The one query is that if they’ll take the financial savings or concede the insurance coverage foyer’s declare that each one efforts to rein in waste, fraud and abuse are “Medicare cuts.”
This selection will outline Republican credibility on authorities waste for years to return. The chance is concrete and bipartisan.
The No UPCODE Act, launched by Sen. Invoice Cassidy, R-La., and Sen. Jeff Merkley, D-Ore., would instantly assault Medicare overbilling. It ensures that sufferers are identified by medical doctors, not insurance coverage firms seeking to maximize funds.
Right here’s how the fraud works: Medicare pays insurers extra when sufferers seem sicker on paper. Insurers reply by including diagnoses that medical doctors by no means made to get increased authorities funds.
UnitedHealthcare, the nation’s largest Medicare Benefit insurer, is beneath federal investigation for this. The Congressional Funds Workplace estimates that stopping it could save taxpayers $124 billion over the subsequent decade.
Cassidy, a doctor, frames the stakes clearly: “The Medicare Belief Fund goes bust in eight years.”
For anybody involved about fiscal accountability, this needs to be simple. President Trump has repeatedly known as for eliminating Medicare waste, but the invoice has stalled in Congress. Insurance coverage firms have mobilized an intense lobbying marketing campaign to cease it.
UnitedHealthcare doubled its Washington spending to $7.7 million within the first half of 2025. Its technique is to reframe anti-fraud measures as “Medicare cuts” to intimidate Congress into inaction.
In actuality, stopping fraud signifies that extra funds are allotted to affected person care moderately than insurance coverage firm earnings. A number of key Republicans acknowledge this chance.
Senate Finance Chairman Mike Crapo, R-Idaho, helps the invoice, joined by GOP colleagues Roger Marshall of Kansas and Mike Rounds of South Dakota. Mehmet Oz, now main the Facilities for Medicare and Medicaid Companies, has introduced expanded auditing to “crush fraud, waste and abuse.”
But, Republicans know insurance coverage firms will spend thousands and thousands portraying any motion as an assault on seniors. This playbook has protected wasteful spending for many years.
The stakes are excessive for Republicans who marketing campaign on fiscal accountability. Sen. Rand Paul, R-Ky., just lately lamented that Republicans “as soon as knew learn how to repair the deficit” however at the moment are “shedding the battle.”
When each events agree that spending is an issue, apparent options shouldn’t be ignored. Medicare beneficiaries acquire nothing from overbilling schemes besides increased premiums and weakened program solvency.
The insurance coverage trade’s fierce resistance exposes what’s at stake — defending billions in unearned earnings. Eliminating overbilling would pressure insurers to compete on effectivity and high quality of care moderately than gaming fee formulation.
Mark Merritt is a well being coverage skilled who has labored at a number of well being organizations/InsideSources
