Congressional Democrats Urge GOP to Address Medicare Advantage Upcoding Over Medicaid Cuts

Over 40 Democratic lawmakers have urged Senate and House GOP leaders to halt Medicaid cuts and instead target Medicare Advantage upcoding, a practice where private insurers manipulate patient diagnoses to inflate profits. Reports suggest Medicare overpaid private insurers by $50 billion in 2024 due to unverified diagnoses, contributing to $83 billion excess payments compared to traditional Medicare. The Democrats highlight the need to address waste, fraud, and abuse in private, for-profit insurance companies to reduce federal spending inefficiencies.

The lawmakers warn that GOP-proposed budget cuts to Medicaid could jeopardize healthcare access for millions of working-class Americans. According to a Congressional Budget Office analysis, these proposals could lead to removal of Medicaid coverage for 2.3 to 8.6 million people, potentially leaving 5.5 million uninsured by 2034, particularly affecting states that expanded Medicaid under the ACA. The debate centers around balancing cost reduction and maintaining healthcare coverage for vulnerable populations within federal programs.