John is 70 years old, managing diabetes and high blood pressure with doctors he has trusted for years, but that stability disappeared overnight when his health system dropped its Medicare Advantage (MA) contracts, abruptly pushing his care out of network. Now, John faces a dilemma: choose a new MA plan that may or may not cover his current caregivers, pay thousands more to keep the doctors who know his history, or switch to traditional Medicare and absorb as much as $750 in additional monthly premiums required under a Medigap plan.
This story isn’t unique. As more health systems exit MA contracts this year, hundreds of thousands of seniors are being forced into similar lose‑lose scenarios, driven not by medical need but by policy instability and biased characterizations.
The recent proposal by the Centers for Medicare and Medicaid Services (CMS) to freeze MA rates has had a cascading effect within the healthcare market. At a time when affordability is Americans’ top economic concern, this decision - and the flawed narrative that MA payments far exceed traditional Medicare - threatens both the program’s future and the health of 35 million seniors. It’s vital that public and private sectors push back against this characterization and reinforce the deep value of MA as a system that lowers the cost of care and improves outcomes. If we don’t see an increase in rates and a reassessment of this incorrect financial analysis, MA faces a swift erosion that will threaten affordability and access for older adults and ultimately many more.
Rewriting a Flawed Narrative
A report from the Healthcare Leadership Council recently highlighted a flawed narrative that has emerged over the past few years, buttressed by inaccurate reports from the Medicare Payment Advisory Commission (MedPAC) claiming billions in MA overpayments. Not only does MedPAC fail to attempt to quantify the value of the additional benefits, affordability, and care coordination that MA offers beneficiaries, but its recent reports have created fabricated “overpayment estimates” using a new and highly contested methodology.
MedPAC should revise these analyses, and Congress should stop treating contested estimates as gospel. The Commission’s recent decision to lower its overpayment estimate – after incorporating more accurate and complete data – only underscores how fragile and assumption‑driven its conclusions remain.
When we allow these unsound estimates to go unchecked, it leads to bad policies like broad cuts across the MA ecosystem. This not only impacts seniors who depend on the program but disproportionately burdens smaller providers and plans that are already hurting from several years of financial pressures. Instead of sweeping changes, efforts to address bad actors gaming the system should be targeted, surgical fixes that help preserve the effective, efficient program that MA continues to be.
MA as a Model for More Affordable Care
Not only does MA deliver better results for patients, but it’s also the most effective tool to address the urgent problem of healthcare affordability. MA enrollees experience 52% fewer emergency room visits and save more than $3,500 annually compared to traditional Medicare. A recent poll finds that more than half of Americans are more concerned about affording healthcare than food or rent. MA offers a solution: value-based care at scale.
MemorialCare, a healthcare system in Orange and Los Angeles Counties, has been leading in value-based models of care for more than a decade, creating Accountable Care Organizations, Direct-to-Employer arrangements, risk-based contracts, and advancing MA. Last year, MemorialCare’s virtual eConsults eliminated 70% of unnecessary specialist visits and direct-to-employer partnerships save companies millions each year.
All of these arrangements are rooted in accountability over outcomes. MemorialCare uses its network of primary care doctors to coordinate, prioritizing prevention and personalized care over the traditional siloed fee-for-service model. The result is a reduction in duplicative and costly treatment like MRIs and bloodwork paired with more personalized management of chronic conditions like heart disease, ultimately reducing emergency department visits and the need for costlier treatment later.
MemorialCare has found that this kind of integrated care, in which doctors are held accountable for outcomes, leads to care that is better for seniors, better for providers, and better for the financial health of the system long-term.
Investing in Value-Based Care
MA delivers exactly what the Trump Administration demands: better outcomes at a lower cost. The mischaracterization of the program in the media and in the halls of Congress is contributing to its deterioration. Instead of attacking a system that works, we must invest in the principles that make MA effective. This includes better coordination that reduces costly duplication, and care that’s focused on preventing disease rather than treating it.
But MedPAC reports fail to acknowledge the importance of value-based care and the current and potential cost-savings it offers. As we see systems pull out of MA contracts, it threatens a backtracking away from the progress made around value-based care.
This year, as healthcare affordability takes center stage, Congress has a choice: support a program that is working for millions or watch as costs become entirely out of reach for seniors and their families. For John and millions of patients like him, the choice is clear, and it should be for policymakers, too.
Barry Arbuckle, Ph.D. is CEO of MemorialCare, a leading Southern California non-profit integrated healthcare system with over 200 sites of care.
Maria Ghazal serves as President and CEO of the Healthcare Leadership Council (HLC), the leading healthcare industry association representing all segments of American healthcare.
