“No UPCODE Act” Jeopardizes Florida’s Medicare Advantage Success
Opinion By Tom Gaitens (Photo: Senior Woman’s Hands)
Florida is home to the second-highest number of Medicare Advantage (MA) enrollees in the country, and for good reason: the MA system is a textbook example of how market-based solutions can deliver better health outcomes, more choices, and lower costs for consumers. With nearly 3 million Floridians depending on it, any attack on Medicare Advantage is an attack on freedom, competition, and common-sense healthcare policy.
Unfortunately, the federal “No UPCODE Act,” introduced by Senator Bill Cassidy, is a threat to the very foundation of this successful program. Despite its wonky language and technical jargon, this bill would impose top-down mandates that limit how insurers can assess the health needs of patients, effectively punishing innovation and efficiency while threatening the care options seniors have come to rely on.
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As a longtime champion of Medicare Advantage and fiscal sanity, Senator Rick Scott should reject this misguided, bureaucratic overreach. We can’t let Washington policymakers micromanage a system that’s doing exactly what it was designed to do: empower seniors through competition, deliver better care, and lower costs.
At the heart of the MA program is a principle appreciated by anyone who values choice and innovation: risk adjustment. Insurers use real clinical data—including chart reviews and Health Risk Assessments (HRAs)—to understand a patient’s true health needs. These tools are not bureaucratic fluff; they help doctors diagnose and manage serious conditions like diabetes, heart disease, and depression. This allows funding to follow the patient, not arbitrary formulas—and ensures plans have the flexibility and resources to deliver personalized, timely, and cost-effective care.
But the No UPCODE Act would handcuff insurers by barring them from using these tools, disrupting the flow of accurate information and crippling the ability of MA plans to serve sicker patients. That means lower reimbursements for treating the most vulnerable, leading directly to higher out-of-pocket costs, reduced benefits, fewer plan offerings—and ultimately, fewer choices for seniors.
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This isn’t just bad policy—it’s harmful for those who can least afford it. Medicare Advantage enrollees are, on average, older and sicker than those on traditional Medicare. Nearly 40% of them qualify for low-income subsidies. These seniors need affordable, high-quality care—not red tape and regulation that pushes prices up and coverage down.
Let’s be clear: Medicare Advantage is working—not because Washington commands it, but because the market demands it. MA beneficiaries spend about $3,500 less per year on out-of-pocket costs compared to traditional Medicare. Their health outcomes are better. Avoidable hospitalizations are down. Preventative care usage is up. Why? Because providers have the right incentives to keep people healthy, not just fill hospital beds.
This is what principled, market-based healthcare reform looks like. We should be expanding on it—not tearing it down.
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Senator Scott has always stood for fiscal responsibility, patient choice, and competition in healthcare. We need him now, more than ever, to say no to this harmful legislation and protect the nearly 3 million Floridians who count on Medicare Advantage. Let’s keep Washington out of the exam room—and let the free market keep working for our seniors.
Tom Gaitens is a former GOP State Committeeman for Hillsborough County and an original founder of the Tea Party Movement. A University of South Florida alumnus is also former state director of FreedomWorks.org and has served on the boards of the Florida Taxpayers Union and James Madison Institute-Tampa Regional.
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