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

S2465

2026 -- S 2465
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LC003266
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
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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
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WHEREAS, In 1965, the federal Social Security Amendments Act was passed,
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establishing healthcare insurance programs for those over age 65 (Medicare) and those with
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limited incomes (Medicaid); and
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WHEREAS, Original Medicare coverage had gaps and un-capped co-insurance costs, but
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instead of simply and directly improving original Medicare, private corporations were invited to
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sell various supplemental and replacement plans for enrollee payments and guaranteed federal
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subsidies; and
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WHEREAS, Medicare today consists of a piecemeal program of federal and private
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programs, namely: Part A (inpatient/hospital coverage), Part B (outpatient/medical coverage),
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"Medigap" coverage (co-pays/deductibles), Part C (Medicare Advantage plans), and Part D
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(prescription drug plans), and generally, enrollees can either choose Traditional Medicare (TM),
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with federally run Parts A and B, and privately run Medigap and Part D plans, or choose
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Medicare Advantage (MA) Part C private plans to completely replace TM; and
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WHEREAS, Insurance companies selling MA plans aggressively market to Medicare
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eligible people without full disclosure of TM costs and benefits compared to MA; and
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WHEREAS, In 2024, fifty-four percent of all eligible beneficiaries in Medicare are
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enrolled in private MA insurance plans which cover mainly those over age 65, as well as others
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with certain medical conditions; and
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WHEREAS, States may only regulate MA plans in very limited ways because of federal

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preemption and generally cannot regulate how MA plans market to potential enrollees; and
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WHEREAS, The data show that privatized Medicare has not once yielded savings for the
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program; conservative estimates by the Medicare Payment Advisory Commission (MedPAC), an
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independent agency created to advise Congress on the Medicare program, show that payments to
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MA plans over the past two decades have always been higher than they would have been for
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patients in TM; and
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WHEREAS, MA plans may offer low or no monthly premiums and cap out-of-pocket
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expenses, but MA plans have been found to cost enrollees more than TM when enrollees become
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seriously ill, such as when they get cancer or have extended hospital stays; and
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WHEREAS, Although MA plans attract enrollees with extra benefits, like coverage for
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dental, vision, or hearing, enrollees who use these benefits often end up paying for most of these
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costs out-of-pocket; and
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WHEREAS, Despite higher payments, MA plans generally spend less per patient and
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provide worse coverage than TM; and
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WHEREAS, Unlike TM, which gives enrollees freedom to go to virtually any doctor or
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hospital in the country, MA provider networks are significantly narrower and geographically
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limited; and
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WHEREAS, Unlike TM, which covers physician's orders without requiring third-party
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approval, MA plans require prior authorizations and have been found to improperly deny about
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13 percent of prior authorization requests; and
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WHEREAS, Beginning in 1965, original Medicare became the primary driver for greater
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healthcare equality because the government required hospitals to desegregate before receiving
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any Medicare funds; and
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WHEREAS, Today, MA has exacerbated healthcare inequality by enrolling
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disproportionately high numbers of disadvantaged populations (e.g., racial minorities, disabled
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individuals, lower income individuals) into plans that often offer worse coverage and care than
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TM; and
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WHEREAS, Retirees are forced into MA plans because about 53 percent of large
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employers (200+ employees) require their retirees to accept a MA plan or lose their retirement
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health benefits; and
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WHEREAS, Barriers to switching to Traditional Medicare, including lack of "guaranteed
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issue" protections, waits for "open enrollment," insurers denying or charging steep prices for
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Medigap Part D drug plans, etc., keep MA enrollees trapped in MA plans; and
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WHEREAS, Medicare Advantage plans have achieved higher revenues by taking actions

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that do not benefit enrollees, including:
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(1) Gaming risk pools by marketing to younger, healthier enrollees ("cherry-picking")
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and incentivizing older, sicker beneficiaries to leave ("lemon-dropping");
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(2) "Upcoding" to make patients seem sicker than they really are to increase
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reimbursements from the federal government;
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(3) Using "utilization management" tools such as prior authorizations, step therapy
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protocols and artificial intelligence (AI) algorithms to delay or prevent medically necessary care;
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(4) Delaying or refusing payments to hospitals so that they are increasingly not accepting
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Medicare Advantage patients; and
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(5) Gaming contract construction to maximize quality payments under the star rating
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system; and
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WHEREAS, Most MA plans are sold by large insurers that have multiple related
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businesses, such as pharmacy benefit managers, and those related businesses can account for
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about 20 percent to 70 percent of spending, parent companies can circumvent Medicare limits on
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profits; and
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WHEREAS, Dozens of fraud lawsuits, inspector general audits and investigations by
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watchdog groups have shown that major health insurers have exploited the program to inflate
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their profits by billions of dollars; and
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WHEREAS, Insurers typically earn twice as much gross profit from their MA plans than
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from other types of insurance and private MA insurers have more than doubled their profit
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margins per enrollee; and
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WHEREAS, Estimated amounts overpaid to MA (between $83 billion and $127 billion in
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2024) are more than the amounts needed to totally eliminate Medicare Part B premiums, or fund
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the entire Medicare Part D prescription drug program, or establish dental, hearing, and vision
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coverage for Medicare and Medicaid enrollees; and
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WHEREAS, United Health Care abruptly ended coverage for Medicare Advantage
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enrollees at Rhode Island's four largest teaching and community hospitals, Rhode Island Hospital,
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Hasbro Children's Hospital, The Miriam Hospital, and Newport Hospital, in July of 2025, a
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decision that disrupted care for more than ten thousand (10,000) patients, forced medically fragile
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seniors to switch providers mid-treatment, and highlighted the risks of allowing corporate
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insurers to control access to essential healthcare institutions in pursuit of greater bargaining
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leverage; and
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WHEREAS, There is a growing bi-partisan effort by federal legislators and the Centers
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for Medicare and Medicaid Services (CMS) to protect patients from the kind of MA problems

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noted above; now, therefore be it
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RESOLVED, That this Senate of the State of Rhode Island hereby recognizes the need
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for the United States government to prioritize patients over corporate profits and protect and
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expand traditional Medicare and hereby respectfully urges Senator Jack Reed, Senator Sheldon
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Whitehouse, Congressman Seth Magaziner, and Congressman Gabe Amo to support and pass
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legislation, and ask the U.S. Department of Health and Human Services Secretary and Centers for
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Medicare and the Medicaid Services Administrator to take immediate administrative actions,
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including to:
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(1) Require MA plans to retain and provide information, contracts, documents, and
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financial data that allows transparency for and accountability to taxpayers and enrollees;
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(2) Conduct more MA plan audits to identify overpayments and fraud;
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(3) Strictly regulate MA marketing to require full disclosure to potential enrollees of
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risks, disadvantages, and possible future costs;
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(4) Reduce incentives or requirements for historically disadvantaged groups to accept an
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inferior MA plan over TM;
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(5) Prohibit MA plans from taking actions that increase their profits without increasing
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healthcare services, including upcoding, risk pool "cherry-picking" and "lemon-dropping", and
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using utilization management that improperly denies or delays medically necessary care and
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timely payments to providers;
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(6) Prohibit MA plans from limiting coverage for beneficiaries seeking expert specialty
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care by imposing overly narrow provider networks;
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(7) Require employers that offer retirement benefits to give employees the option to
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enroll in TM;
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(8) Work with the Justice Department to prosecute and recover improper payments; and
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(9) Redirect funds that currently go towards enriching MA plans to instead go towards
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protecting and expanding traditional Medicare; and be it further
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RESOLVED, That the Secretary of State be and hereby is authorized and directed to
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transmit duly certified copies of this resolution to the Clerk of the United States House of
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Representatives, the Clerk of the United States Senate, and to members of the Rhode Island
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Delegation to the United States Congress.
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