Senate Democrats Tell CMS to Fix Medicare Advantage Before Enrolling Anyone Else in It

Washington, D.C. — A group of Democratic senators led by Elizabeth Warren is pressing federal health officials to clean up Medicare Advantage before the Trump administration rolls out a controversial plan to automatically enroll seniors into the program.

In a letter sent to Centers for Medicare & Medicaid Services Administrator Mehmet Oz, Warren and eight colleagues argued that CMS must address a long list of problems with Medicare Advantage — from inflated insurer payments to prior-authorization denials — rather than expand the program’s footprint. The letter was a direct response to comments from Medicare Director Chris Klomp, who said last month that CMS is exploring models that would route Medicare beneficiaries into Medicare Advantage or accountable care organizations by default.

That idea, which first surfaced in The Heritage Foundation’s Project 2025, has drawn sharp pushback from patient advocates and researchers who say Medicare Advantage already delivers worse care than traditional Medicare for many seniors. The program’s plans denied roughly 4.1 million prior-authorization requests in 2024 alone, according to KFF, and the average enrollee has access to fewer than half the physicians available under traditional Medicare.

The money problem

The senators’ letter leans heavily on the work of MedPAC, the congressional advisory commission that estimates Medicare overpayments to Advantage plans could reach $76 billion in 2026 — and $1.3 trillion over the next decade. Much of that overpayment flows from “coding intensity,” a practice where plans assign more complex diagnosis codes to patients than traditional Medicare would, inflating risk-adjustment payments. For nursing homes, that dynamic has already translated into prior-authorization walls, restricted networks, and reimbursement disputes that operators say are getting worse. It’s a trend that’s drawn attention from both sides of the aisle, with a separate bipartisan group of senators also pushing CMS to tackle Medicare Advantage upcoding.

The Democrats want CMS to adopt MedPAC’s recommendations to exclude diagnoses from chart reviews and health risk assessments when calculating risk scores — a change that would reduce overpayments but likely trigger significant pushback from the insurance industry.

What nursing homes are watching

For skilled nursing facilities, the stakes in this fight are considerable. As Medicare Advantage enrollment has grown — it now covers more than half of all Medicare beneficiaries — nursing homes have had to navigate a patchwork of prior-authorization requirements, narrowed networks, and late payments that don’t exist under traditional Medicare.

The senators argue that automatic enrollment would make all of that worse by pushing more beneficiaries into plans before CMS has fixed the underlying problems. They also said the Klomp proposal likely violates the legal requirements that any CMS Innovation Center model must reduce overall federal spending — a point that could give regulators pause before moving forward.

For now, the proposal remains just that — a proposal. But the Warren letter signals that any move toward default enrollment will face a fight on Capitol Hill, and nursing home operators who depend on traditional Medicare’s relatively straightforward reimbursement have reason to pay close attention to how it unfolds.