As the U.S. Senate navigates its ambitious megabill, a Medicare reform proposal has sparked bipartisan interest, though with significant political nuance. The No UPCODE Act, sponsored by Louisiana Republican Bill Cassidy and Oregon Democrat Jeff Merkley, addresses potential overpayments to Medicare Advantage plans. Merkley, a key Democratic senator, has endorsed the policy, calling it “common sense” and stating that insurers should not be allowed to overcharge taxpayers for care. Yet, he insists the legislation should be considered through regular order rather than as part of a partisan package, which he warns could jeopardize 16 million people’s healthcare access. This stance has given Republicans cover as they search for cost-saving measures to offset the financial burden of tax cuts. The potential savings from integrating No UPCODE into the megabill exceed $100 billion, which could help Republicans soften politically sensitive provisions in the House’s version.
Despite this, House Republicans were initially reluctant to include the legislation, with moderates and representatives in battleground districts warning that the bill’s inclusion might be too politically toxic. The House had debated adding the No UPCODE Act to their version of the megabill but ultimately pulled back, highlighting the delicate balance in shaping such a large legislative package. However, Senate Republicans are now increasingly open to incorporating the proposal, especially with President Donald Trump’s private endorsement of Medicare modifications, as long as they focus on reducing waste, fraud, and abuse. Yet, not all GOP senators agree: Missouri’s Sen. Josh Hawley has openly opposed the idea, emphasizing the potential risks to seniors. Meanwhile, House moderates remain skeptical, with Rep. Brian Fitzpatrick (R-Pa.) expressing the need for further clarification on the scope of the proposal.
The political dynamics around the No UPCODE Act are growing more complex. Speaker Mike Johnson, who leads the House, has yet to address whether the Senate should avoid touching Medicare, though he acknowledged the question remains open. While Democrats are wary of using the GOP’s potential Medicare targeting against them, the focus of the opposition has primarily been on Medicaid, a joint federal-state program for low-income Americans. Nevertheless, the insurance industry has already voiced strong opposition, with Mary Beth Donahue of Better Medicare Alliance warning that the proposal could harm seniors by cutting benefits. Cassidy, on the other hand, argues that the legislation would reduce fraud and waste in Medicare Advantage, which offers private plans with additional benefits. He called the bipartisan support for No UPCODE an understatement, while Merk, the Democratic senator, continues to advocate for its standalone review to ensure its merits are not overshadowed by political considerations in the megabill.