Louisiana's Bill Cassidy has an idea to save money on Medicare. Will Congress take it up?

WASHINGTON — Ever since U.S. senators got their hands on the House-passed One Big Beautiful Bill Act, fiscal conservatives agonized over how better to cover the trillions of dollars the proposed tax cuts would add to the nation's $37 trillion debt.

Few politicians, particularly President Donald Trump, want to touch Medicare, the federal health insurance plan for seniors and some disabled people. Along with Social Security, Medicare is often considered the deadly third rail of American politics.

The massive bill shifts more financial responsibility for Medicaid, which provides health care coverage for low-income people, from the federal government to the states. But that isn't enough to fully pay for Trump's domestic agenda and proposed tax cuts.

The entire bill could be killed either by senators who want to roll back proposed Medicaid cuts and by senators who want additional savings to avoid an even larger deficit.

Additional savings could be wrung out of Medicare, perhaps by raising the 65-year-old eligibility age, some conservatives postulated. More eyed reducing overpayments to private Medicare Advantage plans, which would appease budget hawks seeking more spending cuts in the megabill.

One idea comes from U.S. Sen. Bill Cassidy, R-Baton Rouge, and it could generate up to $270 billion in savings, according to his office — enough to placate some of the concerns that Medicaid reductions don't cover the One Big Beautiful Bill Act's costs.

Cassidy's No UPCODE Act was not integrated into the Senate Finance Committee's recommended changes. Still, the idea could reemerge as negotiations continue.

Cassidy's idea is supported by some lawmakers in both parties. But the influential insurance industry has bellowed objections to No UPCODE, thereby adding another coalition to the ones that oppose Medicaid reductions or some other policy in the thousand-page budget reconciliation bill Trump wants passed.

"They decided just to kind of leave things in the Medicaid space," Cassidy said last week. "There'll be an opportunity to save money for the taxpayer and improve service for Medicare Advantage beneficiaries in the future. It's bipartisan. So, I'm hoping that there will be an appetite for taking this up as soon as we finish the One Big Beautiful Bill."

In traditional Medicare, the federal government reimburses hospitals, physicians and other health care providers, if approved, for services already rendered. About half of the nation's 67 million people on Medicare are enrolled through private insurance companies offering Medicare Advantage plans.

The private plans, generally, cover a wider range of services, such as prescription drugs, without the added charges beneficiaries pay in the traditional plan.

Generally, Cassidy's No UPCODE Act would require private insurers to change aspects of how the federal government calculates the rates it pays.

In particular, the legislation would include limiting the practice of aggressively coding on the front end to capture every possible diagnosis, which allows higher premiums. But when the care is delivered and billed, some of those claims are denied as unnecessary, according to several studies, including one by the Medicare Payment Advisory Commission.

"That's an enormous shift of money from the Medicare program into the coffers of the insurance companies," said Alan Levine, a Louisiana Health Department secretary under Gov. Bobby Jindal who now runs a system of mostly rural hospitals and clinics in 29 counties in the Appalachian Highlands of northeast Tennessee, southwest Virginia, northwest North Carolina and southeast Kentucky.

Levine's Ballad Health, based in Johnson City, Tennessee, is owed about $130 million for services rendered but not paid, he said.

America's Health Insurance Plans, a national trade association representing the health insurance industry headquartered on Pennsylvania Avenue between the White House and the Capitol, counters the No UPCODE Act provisions would jeopardize care for the elderly.

"The President and Congressional leaders made a clear promise to seniors that there would be no cuts to Medicare as part of the budget reconciliation legislation," AHIP President and CEO Mike Tuffin said in a statement last week. "Last-minute attempts to cut Medicare Advantage to fund other priorities would directly undermine that promise and lead to higher costs and reductions in benefits for more than 34 million seniors and people living with disabilities."

Though No UPCODE is not part of the Senate package, Senate Majority Leader John Thune, R-South Dakota, is spending the weekend trying to knit together policies that would convince 51 of the 53 GOP senators in the 100-seat chamber to approve Trump's legislation.

Thune told reporters he hopes to get a full vote this week on the Senate's version of the One Big Beautiful Bill Act.