Calls to “Protect the Integrity of MA while Ensuring it Remains a Strong Option for Beneficiaries”
WASHINGTON — Today, Ways and Means Health Subcommittee Chairman Vern Buchanan led a joint Health and Oversight subcommittees hearing titled “Hearing on Medicare Advantage: Past Lessons, Present Insights, Future Opportunities.” The hearing examined the lessons learned after more than two decades of the modern Medicare Advantage (MA) program, the challenges and opportunities associated with the rapid growth in MA enrollment and targeted improvements that allow MA to continue facilitating quality outcomes for beneficiaries and value for taxpayers.
Witnesses included Dawn Maroney, CEO of Alignment Health Plan and President of Alignment Health; Dr. Brian Miller, Associate Professor of Medicine, Johns Hopkins University and a practicing hospital medicine physician; Dr. David A. Basel, Vice President of Clinical Quality and Population Health Officer at Avera Health; Dr. Sachin Jain, CEO of Senior Care Action Network (SCAN) Health Plans; and Matthew Fiedler, Joseph A. Pechman Senior Fellow in Economic Studies with the Center on Health Policy at the Brookings Institution.
View Congressman Buchanan’s opening remarks and questions.
Here’s what Buchanan said about the importance of protecting the integrity of MA and shifting to a preventive care model that empowers Americans to be the “CEO of their own health:”
Medicare Advantage Delivers Affordable, High-Quality Care for Over 100,000 Seniors in FL-16
Rep. Buchanan: “MA [Medical Advantage] is a very popular health insurance option that plays a vital role in providing high-quality, affordable care to millions of seniors, including over 100,000 from my district in Florida. Nationwide, 54 percent of Medicare beneficiaries choose MA plans over traditional fee-for-service Medicare plans. In Florida, 60 percent of Medicare beneficiaries are enrolled in MA.
“I believe we can protect the integrity of MA while ensuring it remains a strong option for beneficiaries. I look forward to discussing these opportunities with our witnesses today and hope all of my colleagues will focus on the topic at hand.”
Shifting from Fee-for-Service to Prevention Could Save Lives and Trillions of Dollars
Rep. Buchanan: “Let me mention the idea you touched on: prevention. We’re spending $5 trillion in the country. ... $2 trillion on Medicare and Medicaid. It seems like we’re getting sicker at large and we’re spending a lot more money. It seems like everything’s reactive. Instead, you get heart disease, you get obesity, then you try to deal with it, but it just seems like it’s so much more expensive. Can you expand a little bit more on your idea of prevention? ...
“As someone who’s been in business a long time, one of the most important things is to get the incentives and the pay plan right. Part of the problem is our whole system, to me, is broken. We keep spending more and getting less for whatever reason. Someone once said that you have to be the ’CEO of your own health.’ We’ve got to have people take a little more responsibility or encourage them or help educate them to take more responsibility for their own health, but there’s so much misinformation out there. ... We’re spending $5 trillion now. How much more do we have to spend for what we’re getting?
Dr. Sachin Jain, CEO of Senior Care Action Network (SCAN) Health Plans: “I think about this question really in very personal terms. My father was diagnosed with diabetes in 1985. The first time that a physician ... referred him to a dietician was in the year 2006. The reality is that we have a medical system right now that treats people when they become sick but does very little to actually prevent them from becoming sick in the first place. We will pay for expensive procedures on people’s retinas, will pay for their dialysis, we’ll pay for their cardiovascular interventions, but had we actually intervened on my father, who passed a couple of years ago, in the 80s and 90s with lifestyle interventions, with a more intensive focus on actually counseling him on his disease, for pennies on the dollar, he might still be here today.
“That’s the kind of thing that we try to do at SCAN for our Medicare beneficiaries. We try to think about the chronic diseases, intervene upon them early, get them the kind of supplemental benefits that they need to keep them healthy and well. I think there’s incredible opportunities for us to intervene upon people and prevent things. 65, however, is too late. When I meet our Medicare beneficiaries, they’ve had 65 years in a fee-for-service system where they’ve largely been disconnected from primary care, or if they have primary care, we’re focusing on treating their problems when they actually arise as opposed to actually slowing or delaying their progression or preventing them from happening in the first place. I think we have incredible opportunities through Medicare Advantage.”
Expanding Customized Benefits in the Health Insurance Marketplace to Address Chronic Disease
Rep. Buchanan: “Why do you think the whole thing on obesity has become such a big issue? ... I have 10 grandkids [age]10 and under, and I’m very concerned about what they’re eating and what they’re doing. They don’t have any of those issues now, but any kids, I don’t like to see what’s going on in that space.
“Dr. Miller, let me ask you, what’s your thought on prevention? What more can we do? Is our system backward? We’re reacting to the problem. It costs a lot more to react with Stage 4 cancer or something than trying to prevent it in the first place.”
Dr. Brian Miller, Associate Professor of Medicine, Johns Hopkins University: “I think part of this gets around to how we can customize benefits rather than standardize benefits. ... I think actually CMS needs to invest some time and energy working to promote this marketplace so we can have customized health benefits to address chronic disease, to address those who are multi-morbid and live in a skilled nursing facility and also dual eligibles. We could have specialized benefits, specialized marketing advertising regulations and then of course customized network adequacy, so that way we can get the right patient into the right health benefits package and get the right care.”
Buchanan has been a leading advocate in Congress for protecting Medicare Advantage and ending the chronic disease epidemic. In March 2025, Buchanan’s Chronic Disease Flexible Coverage Act (H.R. 919), which expands treatment options provided through employers’ healthcare coverage for Americans living with chronic diseases, passed the House with a unanimous bipartisan vote. In February 2025, Buchanan introduced two bills to promote preventive health: the Permanent Telehealth from Home Act (H.R. 1407) to remove obstructive geographic limitations to telehealth services and the Lung Cancer Screening and Prevention Act (H.R. 1406) to help ensure timely access to advanced screenings for lung cancer.
