Senate Republicans are considering targeted Medicare changes — including reforms to Medicare Advantage — as they begin deliberations on President Donald Trump’s sweeping tax and spending proposal, the “One Big Beautiful Bill,” which passed the House on May 22, according to Politico.
The 1,116-page legislation includes major reforms to Medicaid and the ACA and is projected to increase the number of uninsured Americans by 10.9 million by 2034, according to a June 4 report from the Congressional Budget Office. The CBO also estimates the bill would add $2.4 trillion to the national debt over the next decade, prompting Senate Republicans to pursue cost-saving measures within federal health programs.
One area under heightened scrutiny is Medicare Advantage, the privatized version of Medicare that now covers more than 55% of beneficiaries, according to The Hill. Although increasingly popular, the program has drawn criticism for alleged overpayments tied to upcoding.
“There’s a lot of concern on Capitol Hill about Medicare Advantage,” Sen. Roger Marshall, MD, R-Kan., told Bloomberg Television on June 5. He pointed to bipartisan legislation from Sens. Bill Cassidy, MD, R-La., and Jeff Merkley, D-Ore., that aims to tighten diagnosis coding regulations and could yield up to $275 billion in savings over 10 years, according to lawmakers.
The proposal, called the “No Upcode Act,” was introduced March 25 and seeks to:
- Use two years of diagnostic data in risk adjustment, rather than one.
- Limit use of outdated or unrelated conditions when assessing care costs.
- Ensure Medicare only pays for treatments related to clinically relevant conditions.
- Align assessment methods between traditional Medicare and Medicare Advantage.
Most major MA insurers have faced allegations or settlements related to upcoding in recent years, and calls for stronger oversight have gained bipartisan momentum.
President Trump’s budget proposal is expected to undergo further revisions in the Senate as lawmakers work to unify GOP support and deliver the bill to the president’s desk by July 4.
