Will Medicare wither on the vine? How Congress has advantaged Medicare Advantage--and what's a level playing field anyway?

Document Type

Journal Article

Publication Date



St. Louis University Journal of Health Law and Policy


Volume 1, Issue 1


Medicaid & SCHIP; Medicare


While Congress debates reducing the payments Medicare Advantage (MA) plans receive in excess of what Medicare pays for the same services under the traditional fee-for-service program, the authors assert that policymakers need to explore a more fundamental question: should the playing field on which MA plans and traditional Medicare compete be level? If it should, then how can a level playing field be achieved and maintained? This article examines why the playing field is severely tilted in favor of MA plans and offers suggestions for how it might be leveled, including modifying payments to promote payment equity between plans. The authors also consider less-discussed factors that contribute to the unlevel playing field, including benefit flexibility that plans can offer, opportunities for and abuses of plan marketing, and unique advantages enjoyed by private fee-for-service plans. The authors conclude with a discussion of how “boosterism” of private plans by the Centers for Medicare and Medicaid Services demonstrates the need for even-handedness in the administration of Medicare.


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Peer Reviewed


Open Access