In a statement submitted to the House Energy and Commerce Subcommittee on Health for a hearing Jan. 31 on national health expenditures, AHA urged the subcommittee to prevent certain Medicare Advantage plans from engaging in tactics that restrict and delay access to care while adding burden and cost to the health care system.

“While MA plans were designed to help increase efficiency in the Medicare program, recently released data from the Medicare Payment Advisory Commission (MedPAC) found that MA plans will be responsible for $88 billion in excess federal spending this year, due in part to inappropriate upcoding practices, whereby plans report enrollees as having more health conditions and being sicker than they are to receive higher reimbursements,” the statement notes. “At the same time, health insurance premiums continue to grow — in fact, annual insurance premiums increased nearly twice as much as hospital prices over a ten-year period. Additionally, inappropriate denials for prior authorization and coverage of medically necessary services remain a pervasive problem among certain MA plans.”

AHA also urged the subcommittee to address the high cost of prescription medications, and strongly opposed efforts to expand site-neutral payment cuts as part of the Lower Costs, More Transparency Act. AHA said it also opposes provisions in the House-passed bill that would require a separate unique health identifier and attestation of Medicare compliance for each off-campus hospital outpatient department, and undermine the work hospitals have done to provide price information to consumers.

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