For years, Medicare Advantage (MA) providers have marketed their plans with celebrity endorsements, promises of extra dental, vision, and hearing benefits, and the appeal of low or zero monthly premiums. But for millions of older adults, that illusory promise of stable coverage is colliding with a harsh reality.

Unsatisfied with profits, insurance giants like Humana, United HealthCare and Aetna are pulling out of some markets entirely, leaving Medicare Advantage patients stranded. People enrolled in these plans will be forced to look elsewhere for their coverage in 2027. 

We have often criticized Medicare Advantage insurers for putting profits ahead of patients. Humana’s CFO just confirmed it:::

“Increasingly, we’re very much focused on the capital returns of the plan.” -Celeste Mellet, CFO, Humana

This will be the second year in a row that Humana has downsized its MA offerings. Going into 2026, the company scrapped plans in three states and 194 counties, affecting roughly 500,000 seniors. Now, Humana has announced additional “targeted plan exits” expected to affect approximately 600,000 enrollees in 2027, as it seeks to prioritize “higher-performing plans” and improve its profit margins.

The pattern should be familiar to observers of venture capital and startups. Companies use attractive introductory offerings, splashy advertising, and consumer-friendly promises to build market share. Once this is established (and competition has been neutralized), plans can be scaled back, repriced, or eliminated — and consumers (or in this case, patients) are left to deal with the fallout. 

Joe Namath is one of the celebrity spokespeople who hawked Medicare Advantage plans

For Medicare Advantage patients managing cancer, diabetes, heart disease, disability, or multiple chronic conditions, this can disrupt long-standing relationships with doctors and specialists – and create real uncertainty about whether necessary care will remain available and affordable.

Humana is not alone in this trend. A recent Johns Hopkins analysis found that approximately one in 10 people enrolled in Medicare Advantage HMO and PPO plans — about 2.9 million beneficiaries — were forced to disenroll from their current plan for 2026 because the insurer exited the market. That is a dramatic increase from the roughly 1 percent annual forced-disenrollment rate reported between 2018 and 2024.

The disruption can be especially severe in rural communities. In these places, MA enrollment is highly concentrated among a small number of insurers. One dominant company abandoning the market can leave beneficiaries in rural areas with scant alternatives. A plan may still be available, but it may not include the same doctors, hospitals, prescription drugs, supplemental benefits, or out-of-pocket costs. 

Trump’s Medicaid Work Requirements Will Deprive Millions of Health Coverage 

While the private sector shortchanges Medicare patients, the Trump administration and congressional Republicans are wreaking havoc on Medicaid. Trump’s Big, Ugly Bill imposed new work requirements that are already stripping people of health coverage, even though the law’s main provisions don’t take effect until 2027 (conveniently, after the mid-terms). 

Justice in Aging’s Natalie Kean says Medicaid work requirements do not encourage work

Under new federal rules, certain Medicaid patients will generally need to demonstrate 80 hours per month of qualifying activities* to maintain eligibility. Trump and the GOP framed these requirements as a way to encourage work or curb ‘waste.’ In truth, they create mountains of red tape — and will not ‘encourage work.’ Just look at past experiments with work requirements, which had no impact on workforce participation, but did cause vulnerable people to lose health coverage. 

NEWS FLASH:  More than two thirds of adults on Medicaid already work, and the remainder are not working due to legitimate barriers such as caregiving, illness, disability, or attending school.

“The new requirements are not going to increase work and they’re going to make people less healthy,” said Natalie Kean of Justice in Aging on a recent episode of our podcast. 

“People are going to be in this situation where they’re trying to work, but don’t have healthcare. And then their health is going to get worse, which is going to make it harder for them to work. It’s really a paradox.” – Natalie Kean, Justice in Aging 

The stakes are especially high in communities where Medicaid is a central source of care. New York State health officials estimate that at least 475,000 residents could lose Medicaid coverage because of the new work requirements. In New York City, communities in the South Bronx, East Harlem, Brownsville, and parts of Queens may be particularly at risk because so many residents depend on Medicaid for primary care, prescriptions, and home health services.

The Big, Ugly Bill cut nearly $1 trillion from Medicaid. It’s expected to result in up to 10 million people losing their coverage. And for what? So that Trump and his party can shower the wealthy with tax breaks they didn’t need. Most developed nations have some form of universal medical coverage, based on the belief that health care is a human right. The United States is not one of them.  In fact, under the current regime, one of the wealthiest nations on Earth is stripping its people of health care to further enrich the already wealthy and big insurance companies who prioritize profits over patients. 

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*Enrollees are now subject to work and “community-engagement” requirements that could make people repeatedly document work, school attendance, job training, volunteer activity, income, health conditions, or other exemptions in order to keep their coverage.

Listen to our podcast, “Trump’s Big, Ugly Bill: One Year Later” with Natalie Kean of Justice in Aging here.

This post is a reprint of an article published on Substack by NCPSSM President & CEO Max Richtman

When President Franklin D. Roosevelt signed Social Security into law 91 years ago — on August 14, 1935 – he said its enactment was “historic for all time.” FDR was right. Nine decades later, Social Security remains one of the most successful – and most popular – federal programs ever.

In poll after poll, overwhelming majorities of Americans across party lines approve of Social Security – and don’t want to see it cut. Despite public sentiment, there’s been a well-funded, long-term movement to undermine this landmark achievement of FDR’s New Deal. Many on the political right have opposed Social Security from the very beginning.

President Lyndon B. Johnson signed Medicare and Medicaid into law 61 years ago today! These legacy Great Society programs could not be MORE IMPORTANT, but the political right has been targeting them for years. Now… Trump and congressional Republicans have chipped away at health coverage for seniors, people with disabilities, and lower income workers. We asked our legislative and policy director Dan Adcock to reflect on the history of both programs — and the threats they face today.

Q: Why was Medicare created in the first place?

A:  Before Medicare was enacted, many seniors did not have health coverage. Insurance companies weren’t exactly eager to enroll older people. So the Congress and President Johsnon saw the need to create a federal health care program for the elderly. And that’s how we got Medicare in 1965.

Q: So was it a huge legislative accomplishment back then?

A:  Yes, it was huge. Earlier, during President Truman’s time in office, he tried to create a national health care system. And that failed politically. But President Johnson picked up where Truman left off, because of the overwhelming need to provide health care to older people since the private sector wasn’t willing to do that.

Q: And that’s why he invited Truman to the White House for the signing of the Medicare law?

A: Yes. He invited Truman to the bill signing because LBJ was able to fulfill at least some of Truman’s vision.

Q: Why do we celebrate the enactment of Medicare today? 

A: Because it provides every older American with essential health care coverage. And it’s been a great success story. Medicare is America’s most efficient health insurance system, covering some 72 million people while maintaining incredibly low overhead costs (except for the for-profit Medicare Advantage program, which we’ll get to later). All the polling about Medicare indicates that huge majorities of the public approve of it. Medicare is overwhelmingly popular regardless of party affiliation and age. And likewise, proposals to cut the program are equally unpopular.

Q: Why did they create Medicaid simultaneously as a sister program to Medicare?

A: Just as older people had trouble procuring health insurance before 1965, lower income Americans couldn’t afford to buy medical coverage at any age. So that was the reason that Medicaid was created. And then also the fact that, before Medicaid was enacted, the federal government did not help to finance long-term care, which has become enormously important as people tend to be living longer. And now, eligible beneficiaries can receive long-term care in skilled nursing facilities covered by Medicaid — and sometimes in the comfort of their own homes through Medicaid Home and Community-Based Services (HCBS). 

Q:  Some people get confused and think Medicare covers long-term care.

A: No, only Medicaid covers long-term care. But… if you’re admitted to a hospital for three days and need rehab or convalescence care, Medicare will cover it for up to 100 days. And if you still need that level of care after 100 days, you have to pay out of pocket or enroll in Medicaid.

Q: The Medicare Part A hospital trust fund is projected to become depleted in the early 2030s. What can we do to restore it to fiscal health?

A: Yes, we know from the most recent Medicare trustees report that the Part A trust fund reserves will run out in 2033, unless Congress takes action. At that point, there still will be money coming into Medicare in the form of payroll taxes – and 89% of benefits still could be paid. We don’t know for sure what that would look like, because it’s never happened before.  But it would mean that payments to providers (doctors and hospitals) would be cut by 11%. So that’s why Congress needs to intervene and bring more revenue into the program. 

Q: How big a threat to traditional Medicare is the privatized Medicare Advantage program right now?

A: Medicare Advantage was created based on the argument that private insurers could cover beneficiaries at a reduced cost to the federal government. But, unfortunately, it costs more to insure seniors through Medicare Advantage than it does through the traditional Medicare program. Not only are taxpayers picking up the tab, but traditional Medicare beneficiaries are basically subsidizing Medicare Advantage through higher monthly premiums.

Medicare Advantage is now capturing a growing share of the market, largely thanks to billions of dollars in (often deceptive or misleading) advertising by the insurance industry. If enough people join Medicare Advantage over traditional Medicare, that could result in a death spiral where it just becomes too expensive to run traditional Medicare anymore. And then Medicare Advantage – with all of its built-in disadvantages – would become your only option.

Q: What are our political concerns about Medicare with Trump in the White House and the Republicans still in the majority on Capitol Hill?

A: President Trump himself said the federal government can’t afford Medicare (and Medicaid) because of the need for ‘military protection.’ It’s absurd to tell seniors and lower income Americans that their federal health coverage must be cut because of Trump’s war in Iran. We won’t get into the politics of the war here. But we must honor our commitment to provide basic health care to the most vulnerable among us – like every other industrialized nation does. 

Let’s not forget about Trump’s Big, Ugly Bill, which cut nearly $1 trillion from Medicaid. That not only hurts lower income Americans who need that coverage, but it affects seniors who are dually eligible for Medicare and Medicaid — not to mention the millions of elderly who receive long-term care through the Medicaid program. The full impact of those cuts hasn’t even been felt yet, because the most harmful provisions of the Big, Ugly Bill don’t take effect until 2027. 

Q: To wrap things up here, what would you tell people who are concerned about the future of Medicare (and Medicaid)?

A: Let your members of Congress know that you don’t want to see Medicare and Medicaid further cut or undermined. And equally importantly, vote for candidates this fall who understand that, 61 years ago, this country made a commitment to seniors and lower-income people that they would no longer have to live without basic health coverage. We encourage voters to support candidates who will protect seniors and working people in the next Congress. Depending on the result of the next two elections, maybe we can turn this around and undo the damage that Trump and his party have inflicted on these crucial programs.

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Read our CEO’s op-ed in Common Dreams, entitled “Celebrate Medicare & Medicaid – and Protect them from Trump.”

Listen to our podcast episode, “Keep AI Bots Out of Medicare!” 

Soon-to-be retired Senator Dick Durbin’s (D-IL) new PROMISE Act is the latest in a wave of proposals to establish a ‘fiscal commission’ to address Social Security’s looming financial shortfall, instead of allowing Congress to do its job and devise its own proposals.

Durbin’s bill would authorize the four-person Social Security Advisory Board to draft a 50‑year solvency bill that would be fast‑tracked through Congress by the end of the current legislative session.  While it differs from earlier commission proposals, Durbin’s legislation still relies on an outside body to formulate changes to a program that 70 million Americans rely on for basic financial security.

On the latest episode of our Capital Quick Takes video series, communications director Walter Gottlieb interviews our President and CEO Max Richtman about Durbin’s bill and other efforts to create fiscal commissions for Social Security.

WALTER: Senator Durbin and several cosponsors have a bill to create a ‘fiscal commission’ to address Social Security’s solvency problem. We don’t love the idea because it punts the ball over to an outside panel to propose solutions for Social Security – instead of just letting Congress come up with ideas on its own and act. Is that about right?

MAX: These commissions are kind of a legislative approach to avoiding responsibility and accountability. Just to be clear, I have great respect and admiration for Senator Durbin. He has been a longtime champion of Social Security, Medicare, the Older Americans Act, and all of the programs older Americans rely on. I commend him for that.

That said, I have serious concerns about his proposal for a commission that could push through major changes to Social Security in the final days of this Congress. It would likely occur during a lame-duck session, after the election, when many members are on their way out. Those members could be asked to vote on sweeping changes to Americans’ earned benefits, when they’ll no longer be accountable because they’re leaving office. I think that’s a real problem. And I think members of Congress should be 100% responsible for any changes to the Social Security program. 

WALTER: Many of the Fiscal Commission proposals we’ve seen would bypass ‘regular order’ in Congress, meaning that any changes could be fast-tracked to a floor vote before the public or advocates have adequate time to respond.

MAX: That’s exactly right. All these commissions have expedited procedures that do not go through regular order. You know, Social Security is such an important program to everybody, not just seniors, but working people who need these benefits when they retire, who have coverage for life and disability insurance. It’s so important. 

Why not allow members to introduce bills? Hold hearings in committees of jurisdiction? Allow advocates like ourselves testify on proposals? Have legislation that’s voted on, debated and voted on? That’s the way these changes should be made.

WALTER: And just to be clear, we favor revenue-side solutions that would bring more money into Social Security.

MAX: Yes, we support legislation that demands the wealthy begin paying their fair share into Social Security by scrapping the payroll wage cap. The last time Social Security was ‘reformed,’ in 1983, about 90% of wages were subject to the payroll tax. Now, because of rising income inequality, only about 80% of wages are covered. So adjusting the cap is only fair. 

On the other hand, we reject proposals that would cut benefits, including raising the retirement age, means-testing or ‘capping’ benefits, or adopting a more miserly formula for cost-of-living adjustments (COLAs). Seniors should not be asked to bear the burden of strengthening Social Security’s finances. Unfortunately, benefits could be cut more easily through a commission process where individual members of Congress have less accountability. 

WALTER: You worked on Capitol Hill for a long time. Fiscal commissions don’t have a stellar track record, right? In 1983, there was the Greenspan Commission, and in the 2000s we had the Simpson-Bowles Commission. 

MAX: Well, they’re different. The Simpson-Bowles Commission collapsed. They didn’t have the votes to even get a recommendation to Congress, unlike the Greenspan Commission, which produced a proposal for Congress to consider.  Back in 1983, Social Security was only months away from being unable to pay full benefits. The commission helped develop a plan that extended solvency well beyond that immediate crisis. But its proposals still had to go through Congress, which embellished and changed the Greenspan Commission proposal quite extensively.  

WALTER: If the Greenspan Commission actually came through with a proposal that was embellished and acted on, why don’t we want another Greenspan-style Commission today?

MAX:  Because unlike the current commission proposals, the Greenspan panel’s recommendations were not fast-tracked through Congress. After the commission issued its proposals, Congress held public hearings – and lawmakers actively debated and amended the legislation in both the House and Senate Committees of jurisdiction before it was signed into law. 

That is not how Durbin’s commission idea would work, nor any of the similar proposals we’ve seen on Capitol Hill in recent years. Creating a fiscal commission now would set the stage for members of Congress to avoid responsibility. That isn’t right, because it’s their job to step forward and strengthen Social Security without relying on a commission for political cover. We need to make sure they do that.

WALTER: So, these commission proposals would give individual members of Congress political cover to do something deeply unpopular, like cutting benefits?

MAX: Absolutely. And I’d like to note, since this is an election year, that a candidate simply saying, “I support Social Security” isn’t good enough. Candidates need to say where they stand on improving the program for the long term. Do they support bringing in more revenue in a fair, equitable way, or do they support cutting benefits — which I don’t believe most Americans would accept.

Looking Ahead

The National Committee is joining other prominent seniors’ advocates — including AARP — in opposing the latest fiscal commission proposal.  Social Security reforms must be made transparently through standard Congressional processes, with ample time for public scrutiny and debate. Any legislative effort to address the program’s long‑term challenges should start from a simple principle: benefits must be protected and strengthened, not cut — and older Americans, people with disabilities, and survivors deserve a real voice in shaping Social Security’s future.

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Watch the full conversation with Walter and Max on Capital Quick Takes here. 

New reporting shows Affordable Care Act (ACA) premiums are set to spike by an average of 14% in 2027, on top of last year’s double‑digit hike. It’s exactly what you’d expect from a Trump administration that has made life more expensive and health care less secure for the most vulnerable Americans. 

For millions of Americans who buy coverage on the ACA marketplaces, the story of the past two years is simple: the bill got bigger, the help got smaller, and people are walking away from coverage. As our health policy expert Anne Montgomery, puts it: 

“For modest working‑ and middle‑class people — especially those ages 50 to 64 — premiums are jumping far more than 14%. It’s pure sticker shock. If the policy suddenly costs you that much more, many people simply cannot swing it and decide not to buy or continue coverage.” – Anne Montgomery, NCPSSM

The latest premium spikes are not a fundamental flaw of the ACA; they are a direct consequence of reckless policies in today’s Washington. Congressional Republicans purposely let enhanced ACA tax credits expire – making coverage more expensive. Those temporary subsidies, originally expanded during the pandemic, were designed to make premiums affordable for low‑ and middle‑income households. 

When the subsidies disappeared, the monthly amount people had to pay out of pocket jumped — for some people by 100, 200, or even 300%. No wonder ACA enrollment has tanked. Thanks to GOP hostility to the ACA, millions of Americans could no longer afford it. 

While Trump’s party refused to extend ACA tax credits, his misguided tariffs and the deeply unpopular war in Iran has raised the cost of essential medical goods and prescription drugs. In response, insurers are passing these escalated costs along — in the form of higher premiums and cost‑sharing. 

Trump’s Big, Ugly Bill – which slashed nearly $1 trillion from Medicaid — has only exacerbated the problem. The Kaiser Family Foundation reports that some 3.8 million people have lost Medicaid coverage since the bill passed in 2025.  For someone who loses Medicaid, an ACA marketplace plan at today’s prices may not be a realistic option.

Getty Images

By definition, Medicaid beneficiaries are low‑income; if they are pushed off the program and told to “go to the exchange,” they will find premiums far beyond reach. On the flip side, people who drop their ACA coverage due to soaring premiums may try to fall back on Medicaid, only to run into reduced funding and bureaucratic obstacles designed to keep them out. Many will end up in the worst of all worlds: uninsured. 

Instead of trying to mitigate these health coverage losses, the President and his allies in the GOP‑controlled Congress are escalating their crusade against Medicaid. HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz have announced they are cutting off more than $1 billion in Medicaid funding to California and Minnesota, citing “suspected fraud,” without providing concrete evidence. It’s the latest in a series of punitive actions aimed at Blue states, and it threatens the health and well-being of some of our most vulnerable citizens. 

At the same time, Senate Republicans recently voted down a Democratic bill that would have outlawed the use of AI for prior authorization decisions in Medicare. This means that enrollees will continue to have robotic, AI entities make life-or-death coverage determinations. 

Source: Social Security Works

The good news is that the primary fix for the ACA affordability crisis is both clear and achievable. The next Congress could restore and expand the premium tax credits that have expired.  This “absolutely would” translate into lower costs for consumers and bring many people back into the marketplace, according to our health policy expert, Anne Montgomery. 

Restoring subsidies to the levels we saw a few years ago would make plans affordable again for working‑ and middle‑class families who have been forced to drop coverage. There is, “really [no] other fix” that can match that impact in the near term,” says Montgomery. 

That’s the choice facing lawmakers. They can stay on Trump’s course, which prioritizes insurance company profits and tax cuts for the wealthy and large corporations — or they can change direction. November’s midterm elections will be a crucial fork in the road. 

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Listen to our podcast on the dangers of AI in Medicare prior auth HERE