By Chip Kahn, President and CEO, Federation of American Hospitals

Regular readers of my “Fed Flash” newsletters know that I firmly believe coverage is a critical linchpin to securing Americans’ health and wellbeing. In fact, my last note underscored that good health and good coverage go hand in hand. Over 90% of Americans have health coverage – a record high. As we continue the fight to protect gains in coverage, we also must ensure that coverage is up to par and provides patients ready access to the care and services on which they depend.

Today, 54% of all eligible Medicare beneficiaries are covered by Medicare Advantage (MA) plans. Over the past decade, there has been a surge of seniors choosing to be covered by MA plans, jumping from 15 million beneficiaries in 2014 to 33 million in 2024. CBO projects that number will continue to climb to 64% by 2034. Attracted by lower prescription drug costs and non-healthcare “benefits” like gym memberships, and aggressive marketing from brokers, more and more seniors are choosing to enroll in MA plans instead of traditional fee-for-service Medicare. On the surface, this should be fine – Medicare Advantage plans promise seniors the same access and benefits as traditional Medicare, so the theory would be that seniors enrolled in MA are still receiving the health coverage they’ve earned through a lifetime of hard work.

Reality is a bit more complicated. Multiple reports show that Medicare Advantage plans increasingly use narrow networks and prior authorization, among other practices, to delay and deny patients’ access to care. These maneuvers drive up costs for patients and hospitals and get in the way of seniors’ care. In fact, 94% of physicians say prior authorization delays access to patient care and has a negative impact on health outcomes. When MA plans are caught blatantly using prior authorization to delay and deny care, seniors enrolled in these plans are, by definition, not receiving the same access and benefits as traditional Medicare enrollees. This problem is amplified when applied to vulnerable seniors in need of post-acute care.

Same problem, new data. This week, the Coalition to Strengthen America’s Healthcare – a coalition of hospital groups of which FAH is a founding member – released a new study from NORC that found patients enrolled in Medicare Advantage plans are more likely to experience longer hospital stays and are less likely to be discharged to the right setting for their follow-up care than those on Traditional Medicare. Among the most striking findings: Medicare Advantage patients had hospital stays that were 40% longer on average than those with Traditional Medicare. This translates to a full seven days in the hospital on average for MA patients versus five for traditional Medicare patients. These disparities suggest:

• Medicare Advantage plans are limiting post-acute spending by keeping beneficiaries in the hospital longer.
• MA patients are more likely to face delays and reduced access to essential rehabilitation care in the right setting, like an inpatient rehabilitation hospital, following hospitalization.

You shouldn’t have to sit in a hospital for an extra two days on average, and risk receiving needed recovery and rehabilitation care just because of your insurance. Once more – the data shows MA plans are putting their profits before patients, and failing on their promise to provide the same access and benefits as traditional Medicare.

It’s past time to hold managed care accountable. The Coalition’s NORC report shines a light on a problem we’ve long known to exist. In fact, last year a Senate investigation found some insurers denied patients access to post-acute care at three times the rate of all other denials. It’s critical Congress and the new Administration put patients first and provide all seniors with the care, access, and benefits they’ve earned. Managed care plans’ tactics delaying and denying care have gotten out of hand – it’s time to hold them accountable. Seniors deserve better than what they’re receiving.