project 2025–what will it do to medicare?

After reading the Project 2025 document and looking at different synopsis of it, I feel that the Center for American Progress has the best explanation of what will change and be lost.

By making Medicare Advantage—privatized Medicare—the default option for all Medicare enrollees, Project 2025’s plan would lead to a multibillion-dollar giveaway to corporations that would limit older Americans’ health care choices while putting Medicare’s future at risk.

When the Medicare Advantage program was established, private insurers were expected to deliver health care in a more efficient manner than government-run Traditional Medicare does, in theory saving money and improving quality. Yet MA doesn’t save money and, in fact, has been associated with significant wasteful spending for the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent congressional agency that advises Congress on issues affecting the Medicare program, found that in 2024 alone, Medicare will pay MA plans at least $83 million than what it would cost the government to cover those same enrollees in Traditional Medicare.

Currently, Medicare enrollees are split about evenly between Traditional M and Medicare Adavantage. The Heritage Foundation’s Project 2025 calls for MA to be the default enrollment option for all Medicare beneficiaries—which would push the United States toward a future of fully privatized Medicare. The effects of enacting this policy would be a multibillion-dollar annual giveaway to corporations at the expense of Medicare enrollees and taxpayers—and at the expense of Medicare’s financial sustainability.

If making MA the default option for enrollees were to expand the proportion of Medicare beneficiaries in Medicare Advantage to 75 percent—up from its current enrollment level of 51 % and the Center for American Progress reports that wasteful spending could approach $2 trillion over 10 years.

In the name of cost savings, MA plans can sometimes harm patients by limiting choices of physicians and hospitals, requiring burdensome prior authorization for services and medications, and denying doctor-recommended care. This is because MA plans’ cost-saving efforts only benefits the healthcare corporations’ bottom lines.

Once a Medicare enrollee has chosen an Advantage plan, they are expected to stay within a narrow network of providers, which restricts their choice of doctors and hospitals. Compare that with traditional Medicare enrollees, who can see almost any Medicare provider nationwide. Many times, Advantage networks can be very limited: According to a 2017 report, Advantage networks, on average, included fewer than half (46 percent) of all Medicare physicians in a given county. Data show that some Advantage plan networks are restricted to an area as small as a single county and nearly half of Advantage plan networks include no psychiatrists. One study of cancer patients found that Advantage enrollees were 6 percent less likely than Traditional Medicare enrollees to use “top-ranked cancer hospitals for complex cancer surgery,” suggesting that those in Advantage plans have less access to the best cancer care.

In the name of cost savings, Advantage plans also often require burdensome prior authorization for services and medications and sometimes deny doctor-recommended care.

As many of you may have seen recently, prior authorization requirements and care denials have led a growing number of hospitals and health systems to stop accepting some A 2023 report listed a dozen hospitals and health systems that have recently cut ties with MA plans, allegedly as a result of slow, excessive, and unreasonable prior authorization and claims denials that result in financial losses for hospitals. As providers drop Advantage, patients are left with fewer choices, and the Advantage program as a whole becomes less sustainable.

Project 2025’s plan to make Advantage the default option for all enrollees would also likely lead to more people getting stuck in the Advantage program. That is because in all but four states, Advantage enrollees who want to switch from Advantage back to Traditional after a short trial period can be denied supplemental coverage (Medigap), which many enrollees would need to make the switch to TM financially viable. This can trap people with serious health issues in Advantage plans—which may not be the best option for their needs—for the rest of their lives. If Advantage becomes the Medicare default enrollment option for all enrollees, the plans will be guaranteed a steady stream of excessive overpayments, as many enrollees won’t be able to afford to leave them.  Taken from the Center for American Progress

Project 2025 would raid the Medicare trust fund

Insurance company profits have continued to skyrocket over the past decade, in large part to increased revenue from Advantage plans.

The Medicare Hospital Insurance (HI) Trust Fund is projected to be insolvent by 2036 unless congressional action is taken. The Biden-Harris administration has called for extending the solvency of the Medicare trust fund at least 25 years by modestly increasing the Medicare tax rate on income above $400,000, closing loopholes in existing Medicare taxes, dedicating the Medicare net investment income tax to the HI Trust Fund, and crediting savings from prescription drug reforms to the HI Trust Fund. But… Project 2025’s proposal is to enroll even more Medicare beneficiaries in the option that costs 22 percent more per enrollee.

Project 2025’s plan to make Advantage the default option will mean that corporations, not doctors or patients, will be able to control what care an even greater number of enrollees can and cannot receive.

Conclusion

Project 2025 would put more control in the hands of profit-driven corporations by making Advantage the default enrollment option for Medicare beneficiaries. Corporations, not doctors or patients, would be able to control what care an even greater number of enrollees can and cannot receive, while enriching their bottom lines and threatening Medicare’s future.

* CAP estimates that 75 percent enrollment in MA would increase total MA payments from $7.7 trillion to $10.6 trillion from 2024 to 2033. CAP estimates that Medicare spends 22 percent more for enrollees in Advantage than they would cost in Traditional Medicare, leading to $1.9 trillion in total overpayments if 75 percent of beneficiaries were enrolled in MA over this time period.  Center for American Progress

The Health and Human Services portion of Project 2025 starts on page 449. They have worded it in a way where it may sound great to the average consumer until we take a deeper dive and see exactly what this would mean for most Americans…