Middlemen in Medicare Stall Care, Prompting Calls for New Congressional Bills

Across the United States, private Medicare Advantage plans and Medicare Administrative Contractors are systematically postponing or refusing essential medical services, with denial rates climbing to 80% in certain locales. The author, a pathologist, professor, and Orphans’ Court judge, observes that these delays turn manageable conditions into life-threatening ones, burden physicians with endless paperwork, and erode clinical education.

He also notes that the same tactics spread to commercial insurers, creating a nationwide “zip-code” disparity in access to advanced diagnostics and cancer therapies. The resulting administrative gridlock threatens both patient health and the broader biotech innovation pipeline. To counteract the practice, the author advocates two bills: the Improving Seniors’ Timely Access to Care Act and H.R. 8500, which would enforce a strict 60-day review window for coverage decisions and overhaul prior-authorization systems. He calls on the public to pressure Congress to enact these measures before more lives are lost.