Rep. Schakowsky was clarion voice on traditional Medicare

As U.S. Rep. Jan Schakowsky [9th] wraps up her long career in Washington, Illinois senior citizens and others that rely on Medicare will share a sense of loss over one of the biggest critics of Medicare Advantage [MA], a Republican-designed program designed to limit consumer choices while benefitting medical insurance companies.

On May 5, Schakowsky announced her decision not to seek re-election at the end of her current term in 2026.

What will endure after she is gone is the annual season for MA advertisements on television, social media, in big box stores, and telephone marketing.

Underway right now, “Medicare Season” refers to different enrollment periods, with the main ones being the annual Open Enrollment Period from Oct. 15 to Dec. 7 for making a wide range of Medicare and Medicare Advantage plan changes, and the Medicare Advantage Open Enrollment Period from Jan. 1 to March 31 for those in a MA plan to switch to another plan or back to Original Medicare.

While no single person can be credited with calling MA a scam, critics and government reports have highlighted the deceptive marketing practices and fraud that are used to promote MA plans, leading some to view them negatively.

The US Senate Finance Committee, the Illinois Attorney General, and the Mississippi Insurance Dept. have all issued statements about MA, while the New York Times and other media have reported on lawsuits against insurers for alleged fraud. Schakowsky’s earlier statement pledging to protect and improve traditional Medicare will be missed after her departure. “I am strongly opposed to efforts to eliminate Medicare’s guarantees by privatizing it, leaving seniors and people with disabilities on their own to deal with private insurance companies ” she said.

As early as 2003, Schakowsky was on the stump defending traditional Medicare against the Republican onslaught. “We know that the Republican Party has never liked Medicare. In 1995, Bob Dole even bragged about voting against Medicare. [We] had to fight them to get Medicare passed in 1965. And ever since, they have tried to destroy this precious program.”

In 2024, a report by Brandon Novick from the Center for Economic and Policy Research wrote that insurance companies spend significant sums of money to hoodwink seniors with marketing that highlights the supposed advantages of MA, like low upfront costs and gym memberships, while leaving seniors in the dark about the downsides, like heavily restricted networks and denials of necessary care.

Novick identified Myth #1 as including the term Medicare in “Medicare Advantage,” which he says is incredibly misleading as the MA program is de facto government-subsidized private insurance.

Traditional Medicare is public insurance, where tax dollars are directly used to cover healthcare costs for seniors and some disabled people.

In contrast, MA consists of thousands of different plans mostly provided by insurance giants like UnitedHealthcare and Humana. Seven large insurance companies accounted for 84% of MA plan enrollment in 2023.

MA plans make money by spending as little as possible on patient care in order to keep as much of the taxpayer money as possible.

Myth #2 reports that MA has never saved taxpayer money as a substitute for traditional Medicare. “In fact, according to the Medicare Payment Advisory Commission [MedPAC], taxpayers have spent more money on financing MA than they would have if everyone was covered un- der traditional Medicare.

A 2023 study by the Physicians for a National Health Program estimates that the Centers for Medicare and Medicaid Services [CMS] have overpaid MA plans between $88-$140 billion in 2022 alone through practices like pretending patients were sicker than they were along with targeting healthier, less costly seniors to enroll in their plans.

Myth #3 is one of the primary appeals of MA. That is the idea that it saves beneficiaries money. Patients in both traditional Medicare and MA have to pay a monthly premium for Medicare Part B that pays 80% for outpatient services unless the patient has Medigap coverage In MA plans, premiums, coinsurance rates, and deductibles vary across the thousands of different plans. For healthy individuals without need of expensive healthcare services and products, MA saves money due to its low premiums.

However, traditional Medicare users may save thousands of dollars for expensive care that would reach their limit if they were enrolled in MA.

Through incentivizing the use of preventive care, MA’s capitation payment model should supposedly increase the health of its beneficiaries. However, there is not sufficient evidence to prove this.

There are many reasons for poor health outcomes in the U.S., such as lack of healthcare access, high costs, low income, poor diet, and lack of exercise to name a few.

The strategy of giving lump sums of money mostly to insurance company giants and incentivizing them to spend as little as possible is not supported with evidence of improved health outcomes and does not directly tackle these greater issues.

“All in all, Medicare Advantage is a scam,” writes Novick. Congress created MA in 2003. After signing the bill into law, President George W. Bush boasted how MA would lower costs, expand benefits, afford seniors more choices, and improve quality of care.

However, this supposed modernization of Medicare was really a scheme to privatize, gifting billions of dollars to insurance companies while seeking to end traditional Medicare.

In reality, MA has never saved taxpayer money. Through gaming the system of capitation payments, MA insurance companies have reaped billions of taxpayer dollars in overpayments which have also increased the amount all Medicare beneficiaries pay in Part B premiums.