LAS VEGAS—Medicare Advantage has historically enjoyed bipartisan popularity, but, as the program has grown, so too has scrutiny of insurers' practices.
Mike Hoak, vice president of public policy at Humana, said this is a natural cycle for public programs like MA, where policymakers don't want to see it fail or kill it outright but want to continue evolving it to ensure it works effectively.
There was a similar reappraisal of Medicare Part D, he said.
"There is a really bipartisan feeling amongst policymakers: 'I love the program,' and—for some of them, at least—'I'd like to see it grow, but it is time for some nips and tucks,'" Hoak said. "I think Medicare Advantage is at that inflection point right now."
Hoak spoke on a panel about the current state of policy around MA at AHIP 2025 on Monday. He was joined by Elena Tompkins, principal at Tompkins Strategies; Matt Kazan, vice president for policy and government affairs at SCAN Health Plan; and Mark Hamelburg, senior vice president for federal programs at AHIP.
Kazan said the sheer size of MA invites the additional pressure. Enrollment in the program, which is administered by private insurers, has grown to cover more than half of all Medicare eligibles.
Especially in a political environment where stakeholders are hungry to cut costs, it makes an outlay the size of MA hard to ignore, he said. Kazan also acknowledged that the industry has seen its fair share of negative press given concern about risk adjustment, claims denials and profitability.
"I think that puts a target on the program for attention," he said. "And I do think that policymakers are motivated by what they read on Twitter and headlines on the internet. And, for better or for worse, there's been headlines that are unfortunate, and policymakers react to that. "
Tompkins said that while there have been loud critics of MA, in her experience, the pushback on the program isn't necessarily politically motivated. Policymakers on both sides of the aisle view reforms to MA as part of a broader effort to "to fix a program that most people agree is working."
Hoak said that given the need to cut costs now, it's inevitable that policymakers look at Medicare, Medicaid and other public health programs due to the amount of money they're looking to cut.
"If you're really going to take a meaningful attempt at addressing this sort of long-term fiscal health of the country, you have to start touching public health programs," he said. "It's where all the money is."
"Why do people rob banks? It's where the money is," Hoak said.
The panel also drilled down into some of the key challenges in the MA space, including changes to the Centers for Medicare & Medicaid Services' star ratings program, risk adjustment and health risk assessments. In the latter case, plans have been accused of using these assessments to pad diagnoses and, in turn, increase their payments in the program.
Tompkins said part of the challenge involved in setting the record straight around these issues is the consistent turnover in Congress. The first version of what is now MA was introduced in 1997, and just seven senators and 25 representatives who were in Congress then remain today.
That also includes shifts among Capitol Hill staffers, and educating all of these individuals takes time and effort, she said.
"It is a very important constituency to these members, so we're all trying to make sure that we're getting it right," she said. "But I think there are ways to do this without completely overhauling the entire program. It's just getting the information to these members."
Hoak said an example of a reform that would likely garner support is requirements around follow-ups after a health risk assessment, which would prevent inaccurate diagnoses from piling up. But policymakers seeking to put guardrails around the program shouldn't "throw the baby out with the bathwater."
Kazan echoed that while legislators look to root out fraud, waste and abuse in MA and elsewhere, there's a significant risk of government overreach.
"It's a very tricky, very important issue," he said.