SENATE RESOLUTION RESPECTFULLY URGING THE UNITED STATES CONGRESS TO PROTECT PATIENTS AND TRADITIONAL MEDICARE FROM MEDICARE ADVANTAGE, the official text

S2465 2026 -- S 2465 ======== LC003266 ======== STATE OF RHODE ISLAND IN GENERAL ASSEMBLY JANUARY SESSION, A.D. 2026 ____________ S E N A T E R E S O L U T I O N RESPECTFULLY URGING THE UNITED STATES CONGRESS TO PROTECT PATIENTS AND TRADITIONAL MEDICARE FROM MEDICARE ADVANTAGE Introduced By: Senators Ujifusa, Ciccone, Tikoian, DiMario, Lauria, Valverde, Kallman, Murray, Mack, Acosta, and Quezada Date Introduced: February 06, 2026 Referred To: Senate Health & Human Services 1 WHEREAS, In 1965, the federal Social Security Amendments Act was passed, 2 establishing healthcare insurance programs for those over age 65 (Medicare) and those with 3 limited incomes (Medicaid); and 4 WHEREAS, Original Medicare coverage had gaps and un-capped co-insurance costs, but 5 instead of simply and directly improving original Medicare, private corporations were invited to 6 sell various supplemental and replacement plans for enrollee payments and guaranteed federal 7 subsidies; and 8 WHEREAS, Medicare today consists of a piecemeal program of federal and private 9 programs, namely: Part A (inpatient/hospital coverage), Part B (outpatient/medical coverage), 10 Medigap coverage (co-pays/deductibles), Part C (Medicare Advantage plans), and Part D 11 (prescription drug plans), and generally, enrollees can either choose Traditional Medicare (TM), 12 with federally run Parts A and B, and privately run Medigap and Part D plans, or choose 13 Medicare Advantage (MA) Part C private plans to completely replace TM; and 14 WHEREAS, Insurance companies selling MA plans aggressively market to Medicare 15 eligible people without full disclosure of TM costs and benefits compared to MA; and 16 WHEREAS, In 2024, fifty-four percent of all eligible beneficiaries in Medicare are 17 enrolled in private MA insurance plans which cover mainly those over age 65, as well as others 18 with certain medical conditions; and 19 WHEREAS, States may only regulate MA plans in very limited ways because of federal 1 preemption and generally cannot regulate how MA plans market to potential enrollees; and 2 WHEREAS, The data show that privatized Medicare has not once yielded savings for the 3 program; conservative estimates by the Medicare Payment Advisory Commission (MedPAC), an 4 independent agency created to advise Congress on the Medicare program, show that payments to 5 MA plans over the past two decades have always been higher than they would have been for 6 patients in TM; and 7 WHEREAS, MA plans may offer low or no monthly premiums and cap out-of-pocket 8 expenses, but MA plans have been found to cost enrollees more than TM when enrollees become 9 seriously ill, such as when they get cancer or have extended hospital stays; and 10 WHEREAS, Although MA plans attract enrollees with extra benefits, like coverage for 11 dental, vision, or hearing, enrollees who use these benefits often end up paying for most of these 12 costs out-of-pocket; and 13 WHEREAS, Despite higher payments, MA plans generally spend less per patient and 14 provide worse coverage than TM; and 15 WHEREAS, Unlike TM, which gives enrollees freedom to go to virtually any doctor or 16 hospital in the country, MA provider networks are significantly narrower and geographically 17 limited; and 18 WHEREAS, Unlike TM, which covers physician s orders without requiring third-party 19 approval, MA plans require prior authorizations and have been found to improperly deny about 20 13 percent of prior authorization requests; and 21 WHEREAS, Beginning in 1965, original Medicare became the primary driver for greater 22 healthcare equality because the government required hospitals to desegregate before receiving 23 any Medicare funds; and 24 WHEREAS, Today, MA has exacerbated healthcare inequality by enrolling 25 disproportionately high numbers of disadvantaged populations (e.g., racial minorities, disabled 26 individuals, lower income individuals) into plans that often offer worse coverage and care than 27 TM; and 28 WHEREAS, Retirees are forced into MA plans because about 53 percent of large 29 employers (200+ employees) require their retirees to accept a MA plan or lose their retirement 30 health benefits; and 31 WHEREAS, Barriers to switching to Traditional Medicare, including lack of guaranteed 32 issue protections, waits for open enrollment, insurers denying or charging steep prices for 33 Medigap Part D drug plans, etc., keep MA enrollees trapped in MA plans; and 34 WHEREAS, Medicare Advantage plans have achieved higher revenues by taking actions LC003266 - Page 2 of 4 1 that do not benefit enrollees, including: 2 (1) Gaming risk pools by marketing to younger, healthier enrollees ( cherry-picking ) 3 and incentivizing older, sicker beneficiaries to leave ( lemon-dropping ); 4 (2) Upcoding to make patients seem sicker than they really are to increase 5 reimbursements from the federal government; 6 (3) Using utilization management tools such as prior authorizations, step therapy 7 protocols and artificial intelligence (AI) algorithms to delay or prevent medically necessary care; 8 (4) Delaying or refusing payments to hospitals so that they are increasingly not accepting 9 Medicare Advantage patients; and 10 (5) Gaming contract construction to maximize quality payments under the star rating 11 system; and 12 WHEREAS, Most MA plans are sold by large insurers that have multiple related 13 businesses, such as pharmacy benefit managers, and those related businesses can account for 14 about 20 percent to 70 percent of spending, parent companies can circumvent Medicare limits on 15 profits; and 16 WHEREAS, Dozens of fraud lawsuits, inspector general audits and investigations by 17 watchdog groups have shown that major health insurers have exploited the program to inflate 18 their profits by billions of dollars; and 19 WHEREAS, Insurers typically earn twice as much gross profit from their MA plans than 20 from other types of insurance and private MA insurers have more than doubled their profit 21 margins per enrollee; and 22 WHEREAS, Estimated amounts overpaid to MA (between $83 billion and $127 billion in 23 2024) are more than the amounts needed to totally eliminate Medicare Part B premiums, or fund 24 the entire Medicare Part D prescription drug program, or establish dental, hearing, and vision 25 coverage for Medicare and Medicaid enrollees; and 26 WHEREAS, United Health Care abruptly ended coverage for Medicare Advantage 27 enrollees at Rhode Island s four largest teaching and community hospitals, Rhode Island Hospital, 28 Hasbro Children s Hospital, The Miriam Hospital, and Newport Hospital, in July of 2025, a 29 decision that disrupted care for more than ten thousand (10,000) patients, forced medically fragile 30 seniors to switch providers mid-treatment, and highlighted the risks of allowing corporate 31 insurers to control access to essential healthcare institutions in pursuit of greater bargaining 32 leverage; and 33 WHEREAS, There is a growing bi-partisan effort by federal legislators and the Centers 34 for Medicare and Medicaid Services (CMS) to protect patients from the kind of MA problems LC003266 - Page 3 of 4 1 noted above; now, therefore be it 2 RESOLVED, That this Senate of the State of Rhode Island hereby recognizes the need 3 for the United States government to prioritize patients over corporate profits and protect and 4 expand traditional Medicare and hereby respectfully urges Senator Jack Reed, Senator Sheldon 5 Whitehouse, Congressman Seth Magaziner, and Congressman Gabe Amo to support and pass 6 legislation, and ask the U.S. Department of Health and Human Services Secretary and Centers for 7 Medicare and the Medicaid Services Administrator to take immediate administrative actions, 8 including to: 9 (1) Require MA plans to retain and provide information, contracts, documents, and 10 financial data that allows transparency for and accountability to taxpayers and enrollees; 11 (2) Conduct more MA plan audits to identify overpayments and fraud; 12 (3) Strictly regulate MA marketing to require full disclosure to potential enrollees of 13 risks, disadvantages, and possible future costs; 14 (4) Reduce incentives or requirements for historically disadvantaged groups to accept an 15 inferior MA plan over TM; 16 (5) Prohibit MA plans from taking actions that increase their profits without increasing 17 healthcare services, including upcoding, risk pool cherry-picking and lemon-dropping , and 18 using utilization management that improperly denies or delays medically necessary care and 19 timely payments to providers; 20 (6) Prohibit MA plans from limiting coverage for beneficiaries seeking expert specialty 21 care by imposing overly narrow provider networks; 22 (7) Require employers that offer retirement benefits to give employees the option to 23 enroll in TM; 24 (8) Work with the Justice Department to prosecute and recover improper payments; and 25 (9) Redirect funds that currently go towards enriching MA plans to instead go towards 26 protecting and expanding traditional Medicare; and be it further 27 RESOLVED, That the Secretary of State be and hereby is authorized and directed to 28 transmit duly certified copies of this resolution to the Clerk of the United States House of 29 Representatives, the Clerk of the United States Senate, and to members of the Rhode Island 30 Delegation to the United States Congress. ======== LC003266 ======== LC003266 - Page 4 of 4