Earlier this year, millions of seniors breathed a sigh of relief when Congress passed President Donald Trump’s “One Big Beautiful Bill” without cutting Medicare — including the popular Medicare Advantage program, which now covers more than half of all Medicare beneficiaries.
It was a major win for seniors, and hardly a fait accompli. In fact, during budget negotiations, some Republican lawmakers pushed hard for provisions from the “No UPCODE Act,” which would have led to significant cuts to Medicare Advantage – around $124 billion over 10 years, according to a Congressional Budget Office analysis. That would have meant higher costs and fewer benefits for millions of seniors.
Fortunately, President Trump made sure that didn’t happen, reiterating he didn’t want to touch Medicare in the bill. President Trump has repeatedly insisted he won’t cut Medicare, and he was intent on keeping that promise.
But not so fast. Some Republican lawmakers have discussed reviving the No UPCODE Act later this year as part of a broader healthcare package, or as another pay-for to help write off more government spending.
To be sure, there’s a reason for lawmakers to scrutinize Medicare Advantage. The program accounted for around $462 billion in federal spending last year, and with the Trump administration focused on eliminating waste, no part of the budget is being ignored.
In fact, President Trump’s team has already taken meaningful steps to improve accountability — without cutting care for seniors. Earlier this year, the Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz announced that every Medicare Advantage plan will now be audited annually, addressing a long-standing concern among advocates. CMS also committed to speeding up audits from past years, correcting payment issues in closer to real time.
Dr. Oz and HHS Secretary Robert F. Kennedy Jr. also partnered with major health insurers earlier this year to tackle one of the most persistent frustrations in health care: prior authorization. In a significant breakthrough, insurers have agreed to streamline the process and reduce the number of procedures requiring prior approval — a welcome change that will help seniors avoid delays and denials for needed care.
At a press conference announcing the agreement, Dr. Oz emphasized the administration’s commitment to letting industry lead on solutions — not defaulting to more red tape or overregulation. “CMS is open for business,” he declared.
It’s a smart, collaborative approach, which makes it even more troubling that some Republicans are pushing to undercut it with legislation like the No UPCODE Act.
At first glance, the bill might seem like a sensible attempt to rein in overpayments. In Medicare Advantage, plans are paid based on patient risk — the sicker the enrollee, the higher the payment. That makes accurate diagnoses essential. But occasionally, coding errors can result in overpayments or underpayments.
Still, this challenge is modest compared to the uncontrolled spending in traditional Fee-for-Service Medicare, where doctors are paid per procedure, regardless of whether the service is needed. Medicare Advantage, by contrast, is designed to promote value: If plans keep costs down by keeping seniors healthier, they can lower premiums and offer more benefits such as gym memberships and nutrition support. It’s why Medicare Advantage delivers better health outcomes at a lower cost to seniors than Fee-For-Service Medicare.
One important tool in Medicare Advantage is the in-home health assessment, where a licensed clinician visits a beneficiary at home to evaluate their health, identify fall risks, and flag issues like food insecurity. These visits are especially valuable for seniors with mobility issues.
The No UPCODE Act would all but eliminate these assessments by banning them from being used to determine payments. Supporters of the bill argue this would prevent so-called “upcoding,” or the inflation of diagnoses to secure higher payments. But in practice, it would discourage these important preventive visits, leading to fewer accurate diagnoses and depriving plans of the resources needed to care for their members.
That isn’t tackling waste and fraud. It’s a cut to Medicare Advantage, plain and simple. And it would harm the millions of seniors the program is designed to protect.
The fact is that Medicare Advantage is already one of the most transparent and accountable government programs — and with the expanded program audits and prior authorization improvements announced earlier this year, it will become even more so. Why, then, would we layer on needless rules and regulations that would only make it harder for seniors to receive the care they need?
President Trump rejected this bad idea once, and he should do it again. Medicare Advantage is working for our seniors; now, it’s our job as Republicans to protect it.
Cresent Hardy served in the U.S. House of Representatives from 2015 to 2017 and previously served in the Nevada State Assembly.
