AOC scolds Republicans for supporting the for-profit Medicare Advantage waste, fraud, and abuse.

Alexandria Ocasio-Cortez (AOC) explains the Medicare Advantage waste, fraud, and abuse, and challenges Republicans to support an amendment to take back the stolen money to enhance Americans’ healthcare.

AOC scolds Republicans on Medicare Advantage.

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Summary

Rep. Alexandria Ocasio-Cortez used a House markup to confront Republicans who preach about “waste, fraud, and abuse” yet protect the private insurers that siphon an estimated $80-$140 billion a year from the Medicare Advantage program through aggressive “up-coding” and claim denials. Her amendment—built on the bipartisan No UPCODE Act—would claw back those overpayments and reinvest the savings directly into traditional Medicare, exposing the hypocrisy of a GOP that pretends fiscal responsibility while shielding corporate profiteers.

• Targeting the real waste: AOC highlights that the largest source of Medicare waste is not seniors or physicians, but for-profit insurers that inflate patients’ risk scores to pad revenues.
• Enormous price tag: Independent estimates show Medicare Advantage will be overpaid by roughly $84 billion in 2025 alone, with cumulative excess payments topping $124 billion over a decade.
• Bipartisan remedy: The No UPCODE Act, introduced by Senators Cassidy (R-LA) and Merkley (D-OR), would tighten risk-adjustment rules to curb up-coding; AOC’s amendment mirrors that language in the House.
• Regulatory momentum: CMS, under mounting public pressure, has just announced an expanded audit strategy to recover improper Medicare Advantage payments, signaling that AOC’s critique has institutional support.
• Reinvesting in care: Savings would flow back into traditional Medicare, raising provider reimbursement and improving benefits instead of boosting executive bonuses at UnitedHealth, Humana, and Cigna.

AOC’s amendment unmasks conservative austerity rhetoric and affirms that fiscal stewardship means defending public insurance, not fattening Wall Street’s bottom line.

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Republicans have spent the past decade chanting the mantra of “waste, fraud, and abuse.” Yet, they routinely avert their gaze from the biggest heist in the federal budget: the private-insurer raid on Medicare Advantage (MA). In a pointed floor statement, Rep. Alexandria Ocasio-Cortez (AOC) demolished this selective outrage, reminding the nation that MA insurers swallow between $80 billion and $140 billion every year by gaming risk scores and denying care. That sum dwarfs the savings conservatives claim they can wring from cutting food stamps or capping Medicaid, making the party’s silence on MA a case study in corporate capture.

The mechanism is straightforward. Traditional Medicare pays clinicians directly for services rendered, with its overhead hovering below 3 percent. MA inserts a profit-seeking middleman that receives a capitated payment for each enrollee. To inflate those payments, insurers scour electronic records for every conceivable diagnosis—real or speculative—and submit “up-coded” risk profiles to the Centers for Medicare & Medicaid Services (CMS). Because CMS adjusts payments for patient acuity, the higher the documented illness burden, the higher the public subsidy. A 2025 Kaiser Family Foundation brief shows that MA plans’ risk scores now exceed those of demographically similar seniors in traditional Medicare by 12 percent, an artificial gap that translates into tens of billions in overpayments.

Enter the No UPCODE Act—a rare bipartisan attempt to tighten the screws. Drafted by Senators Bill Cassidy, a Louisiana Republican, and Jeff Merkley, an Oregon Democrat, the bill would modernize risk-adjustment formulas, cap excess payments, and instruct CMS to claw back improper reimbursements more aggressively. Public-interest groups like Arnold Ventures project savings of $124 billion over the next decade, enough to extend Medicare’s solvency by a full year without raising taxes or cutting benefits.

AOC’s amendment imports the Senate language into the House budget package, daring Republicans to vote against their talking points. She frames the issue not merely as fiscal prudence but as moral clarity: seniors enter MA lured by low premiums, only to discover restrictive networks and surprise costs when illness strikes. Denials become profit, and profit becomes political donations that sustain the grift. The congresswoman’s rhetorical flourish—naming UnitedHealth, Humana, and Cigna on the record—ensures that the companies cannot hide behind industry front groups.

Timing strengthens her hand. CMS, now led by Dr. Mehmet Oz in an ironic appointment that has nevertheless produced real enforcement zeal, announced last week an “aggressive strategy” to expand MA audits. The agency will hire 2,000 new auditors and revisit historical claims, a signal that administrative action is aligning with legislative momentum. Shareholders noticed: UnitedHealth’s stock dipped on the news, proof that the market believes overpayments prop up insurer earnings.

Progressives view this juncture as pivotal. For decades, conservatives have relied on a three-step playbook: starving public programs, pointing to resulting gaps as evidence of government failure, and funneling the solution through private markets. Medicare Advantage was the crown jewel of that strategy, marketed as “choice” and “innovation” but designed to privatize a cherished entitlement piecemeal. By exposing MA’s ballooning cost, AOC flips the narrative. The waste lies not in government inefficiency but in corporate extraction, and the remedy is not further privatization but a return to publicly administered coverage.

Critics of reform argue that MA enrollees report higher satisfaction rates and receive additional benefits, such as dental care. Yet those perks rely on overpayments; when audits squeeze margins, insurers threaten to drop the extras or exit unprofitable counties, proving that their commitment to seniors is conditional. Traditional Medicare could offer the same benefits nationwide if Congress recaptured the funds now being diverted to shareholders. Moreover, MA’s rosy satisfaction surveys often exclude seniors who switch back to traditional Medicare after encountering barriers to care—a phenomenon researchers call the “healthy-picker effect.”

From a macroeconomic perspective, pruning MA bloat advances both equity and efficiency. Redirecting $80-$140 billion annually into genuine care would strengthen rural hospitals, lift reimbursement for primary-care physicians, and close racial gaps in access. Those investments would ripple through communities far more effectively than the dividends currently enriching UnitedHealth executives. As economist Dean Baker notes, every dollar wasted in MA is a dollar unavailable for childcare, climate resilience, or tuition support—priorities with demonstrable social returns.

Republicans now face an uncomfortable choice. They can side with AOC, Cassidy, Merkley, CMS, and a growing chorus of watchdogs, or they can protect an industry whose profit model depends on misclassifying cataracts as cancer. The conservative brand of fiscal rectitude cannot survive that contradiction indefinitely. Progressives, for their part, aim higher. The amendment should be considered a down payment on universal, single-payer coverage, aka Medicare for All —a system where public risk pooling replaces private profiteering and where healthcare is treated as a right rather than a commodity.

In the end, the Medicare Advantage saga illustrates a broader truth: governing is about deciding who deserves to profit from public dollars. AOC’s amendment insists that those dollars belong in hospital wards and doctors’ offices, not executive stock options. The fight now moves to the House floor, where votes will reveal whether the rhetoric of restraint finally meets the reality of reform.