00:00Thank you, and I want to thank all of our witnesses for their testimony today.
00:03And I just want to note that I've worked with a number of my colleagues across the aisle
00:08to attempt to improve the Medicare Advantage program.
00:12So this is a bipartisan issue.
00:13In fact, I'm working with Mr. Arrington to ensure that MA plans promptly and fairly pay providers for services
00:21to ensure stability for our hospitals and less delays in care for patients.
00:26I've also worked with Ms. Van Dyne to ensure that patients entering post-acute care
00:31have access to the appropriate care setting, irrespective of whether they are on MA or fee-for-service Medicare.
00:39And I welcome those conversations.
00:40I think we need to have those conversations, and I think we need to have those thoughtful conversations.
00:45But we should have had them two months ago when we were marking up the one big ugly bill.
00:51A lot of Republican colleagues want to root out waste and fraud in the MA program.
00:56But let me be clear about what happened.
00:59Two weeks ago, Republicans cut 17 million Americans' health care to root out waste and fraud.
01:07Republicans triggered $500 billion in cuts to Medicare to root out waste and fraud.
01:13And for what?
01:14Because Republicans blew up our deficit by $3.4 trillion.
01:19And that's according to the nonpartisan Congressional Budget Office, their report that came out yesterday.
01:27So you're going to have to forgive me if I'm a little cynical and I don't believe in their commitment to the program integrity.
01:35President Trump also made a promise to the American people.
01:38He said he was going to lower health care costs.
01:41Well, let me ask you, Dr. Jane, you represent 12,600 constituents in my district and a total of about 300,000 covered people.
01:52I know you legally cannot discuss SCAN's Medicare Advantage bid information for 2026 until it gets approved by CMS.
02:00But according to this analysis, over 100 ACA marketplace insurers, premiums are rising by a median of 15% in 2026.
02:11Do you agree with that analysis?
02:13So we're, you know, SCAN does not operate in the exchanges, so we don't necessarily have a lot of visibility into that.
02:22What I will say is that, you know, there is the potential for there to be stress added to the system writ large because of changes in payments.
02:31Our providers may look elsewhere for revenue opportunities.
02:35And I think that might end up having an adverse impact on beneficiaries and other types of insurance plans.
02:42But I would say it's too early to say, really, what the actual impact is going to be across the delivery system and the plan environment.
02:49Okay.
02:49Some insurers are reporting that President Trump's tariffs, possibly on drugs, medical equipment and supplies, are driving a rate increase of about 3% on average.
03:00Do you think that the constant threat of tariffs might impact MA premium increases for next year?
03:07We haven't yet seen any evidence of that, but it's certainly something that we're tracking in the marketplace.
03:12Right now.
03:13Okay.
03:13And while SCAN doesn't participate in the ACA, in your professional opinion, do you believe that failing to renew the ACA enhanced premium tax credits will impact marketplace premiums?
03:26Again, I think any time that there's big shifts in coverage and subsidies, there's potentially, you know, impacts on other lines of business.
03:36So that's something we haven't seen any evidence of yet, but it's obviously very early.
03:41And so it's something we're monitoring for going forward.
03:43Great.
03:44Dr. Fiedler, I want to ask about value and Medicare Advantage.
03:48Right now, I think that one of the flaws in the system is quality measurement.
03:52In the quality bonus program, how are MA plans incentivized to provide high quality?
03:58So, in principle, we measure plans on a variety of, their performance on a variety of different measures in terms of getting patients appropriate care and other measures.
04:10I think my concern is, based on the evidence we have, that it's not particularly effective in encouraging plans to actually improve care,
04:19as opposed to encouraging plans to invest a lot of administrative costs in optimizing their scores on these measures.
04:25I think that one example of how we inaccurately measure plans' performance is the overturn rate for prior authorization denials.
04:35From 2019 through 2023, more than 80 percent of denied prior authorization requests that were appealed were overturned.
04:45And most seniors don't even appeal their authorization denials.
04:49They just kind of give up.
04:50Dr. Jane, would measuring plans' prior authorization overturn rate improve these procedures and potentially decrease delays in care for patients?
05:01I think measuring that kind of rate and making it transparent to beneficiaries is one of, I think, the best ideas out there to actually create real transparency for folks about what they're actually buying.
05:14I think one of the biggest challenges with the Medicare Advantage industry right now is that many of the beneficiaries don't actually know what it is that they're buying,
05:24because they may not have an active health care need.
05:27A few years later, they may develop, you know, a cancer, and they would like to go to an out-of-network cancer center.
05:35And unfortunately, it's not necessarily available to them, and they didn't know that that wouldn't be the case.
05:40And so, again, I think that the idea that you proposed, the idea of making transparent the overturn rate is one of these, you know, kind of great ideas that could potentially make the program far more transparent to people
05:56and hopefully, over time, improve performance.
05:59I appreciate your testimony, and I yield back.
Be the first to comment