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justaprogressive

(7,140 posts)
Thu May 14, 2026, 11:27 AM 10 hrs ago

Rolling Back Medicare Advantage by Robert Kuttner



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/]
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Rolling Back Medicare Advantage by Robert Kuttner (Original Post) justaprogressive 10 hrs ago OP
Aren't in-network doctors being squeezed too? bucolic_frolic 10 hrs ago #1
Good that everyone could come to a consensus agreement MichMan 10 hrs ago #2

bucolic_frolic

(55,757 posts)
1. Aren't in-network doctors being squeezed too?
Thu May 14, 2026, 11:37 AM
10 hrs ago

How do they tolerate this? Maybe each joins some network? Don't the patients get less time, routine care shuffled off to NP's? And what of Tele-Health doctors? They ain't cheap.

MichMan

(17,380 posts)
2. Good that everyone could come to a consensus agreement
Thu May 14, 2026, 11:52 AM
10 hrs ago

The retirees are going to have to pick up coverage for dental, optical and hearing, plus Part b deductibles.

The deal that the retirees made with the state will involve some cost-sharing. “Our strategy was to meet the state halfway,” Russell said.


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