Sen. Tom Cotton (R-Ark.) in a tweet on February 6, 2023

More than 60 million people rely on Medicare for health coverage, and raising the alarm about potential cuts to the program is a perennial talking point among both Republicans and Democrats.

On Feb. 6, Sen. Tom Cotton (R-Ark.) took a swing at President Joe Biden on Twitter after Biden tweeted that House Republicans were threatening to cut Social Security and Medicare.

“It’s President Biden who is proposing to cut Medicare Advantage, a program used by almost 4 in 10 Arkansas seniors,” Cotton wrote.

It wasn’t clear from Cotton’s tweet which Biden proposal he was referring to, and his office did not respond to requests for comment.

It's President Biden who is proposing to cut Medicare Advantage, a program used by almost 4 in 10 Arkansas seniors. This would be a mistake.

— Tom Cotton (@TomCottonAR)

Ìýpolicies, administered through Medicare-approved private insurance companies, bundle the traditional Medicare program’s separate hospital, medical, and prescription drug coverage into one plan.

The plans are optional and canÌýÌýwhile offering other benefits, including vision and dental services, that are not included in the original Medicare program.Ìý

About 28 million people, or nearly half of those eligible for Medicare, were enrolled in Medicare Advantage plans in 2022, .

The Centers for Medicare & Medicaid Services recently announced two proposed changes that could affect Medicare Advantage insurers:Ìý

• One is aÌý, set to take effect April 3, that’s intended to increase the government’s ability to audit Medicare Advantage plans and recover past overpayments.Ìý
• The other is anÌýÌýthat would modify Medicare Advantage’s risk adjustment model, which determines how much the government pays insurers for beneficiaries’Ìýreported health conditions.Ìý

Health care policy experts said it is most likely that Cotton’s tweet was referring to theÌýÌýintended to increase the government’s ability to recover overpayments.

The rule change would return billions of dollars to the federal government and is likely to reduce private insurers’Ìýprofits, though experts say the reductions would be minimal compared with overall spending.Ìý

Those companies might, in turn, increase enrollees’Ìýout-of-pocket costs or reduce benefits, experts said. But it is unclear if that will happen.Ìý

Meanwhile, the second change — an annual update to the rates paid to Medicare Advantage insurers — will reduce payments to Medicare Advantage insurers. But the reductions will be offset by other program modifications that are projected to yield a 1% increase in Medicare Advantage spending per person in 2024.

A group that lobbies for Medicare Advantage plans sent aÌýÌýthat said proposed changes would affect 30 million beneficiaries, .

What Is the Proposed Rule Change to Medicare Advantage?

The federal government pays private insurance companies for Medicare Advantage per patient, making adjustments to the amounts based on the health of a beneficiary.

The sicker a Medicare Advantage patient is, the more money a private insurer will receive from the federal government to cover the cost of care. Experts said there’s been a longtime concern that Medicare Advantage insurers have a financial incentive to identify preexisting conditions among enrollees.

Auditors from the federal government review medical files to confirm whether patients have the diseases that their private insurers listed, KHN has reported. These audits showed that private insurers had Ìýfor patients that could not be verified, resulting in millions of dollars of overpayments to .

When overpayments are identified, private insurersÌýÌýthe difference to the federal government.

The administrativeÌýÌýthat would allow the government to recoup overpayments is a new version of a rule , under the Trump administration. The final rule comes after the government Ìýhow to identify and recover overpayments, experts said.

“The essence of this rule is to set up procedures whereby the Medicare program can recoup the overcharge,” said Joseph Antos, a health policy expert at the American Enterprise Institute, a conservative-leaning think tank.

From 2023 through 2032, , the federal government will recover $4.7 billion in overpayments from major insurance companies including Humana, UnitedHealthcare, and Aetna. That money represents about one-fifth of 1% of federal payments to Medicare Advantage plans during that period,Ìý, director of Medicare’s Center for Program Integrity.

Though the rule change is expected to reduce private health insurance companies’Ìýrevenues from Medicare Advantage plans, the Department of Health and Human Services doesn’t consider that to be a “cut.”Ìý

“Auditing plans and recouping funds puts money back in the Medicare trust funds when big insurance companies get caught taking advantage of the Medicare program,” Kamara Jones, a spokesperson for the department, told PolitiFact. This is about “holding our seniors’ health care to the standard they deserve.”

CMS is also requiredÌýÌýÌýto ensure accurate payments and prevent fraud, waste, and abuse.Ìý

Experts said they would not characterize the rule change as a “cut.”Ìý

The federal government is attempting to avoid paying more than it should, said Paul Ginsburg, a senior fellow at the University of Southern California Schaeffer Center for Health Policy and Economics. “To me, that is simply running the program better and more efficiently to protect the integrity of the federal funds being used for it.”

How Will Enrollees Be Affected?

It’s difficult to determine whether Medicare Advantage enrollees will feel the rule changes.Ìý

“My read of the evidence is that reductions in payments to Medicare Advantage plans are largely borne by the plans themselves, either through lower profits or cost reductions,” said Matthew Fiedler, a senior fellow with the University of Southern California-Brookings Schaeffer Initiative for Health Policy.

A Ìýfrom Avalere, a health care consulting company, found that the rule change could result in beneficiaries facing higher costs or fewer plan options or benefits.

Because private insurers’Ìýprofits will be reduced, companies could pass along those costs to enrollees in small ways, including slight increases in insurance premiums or out-of-pocket costs and, in some cases, fewer benefits, the American Enterprise Institute’s Antos said.

Antos said he did not expect drastic cost increases or benefit reductions that would encourage enrollees to turn to non-Medicare Advantage plans.

Ìýthat the other proposed 2024 updates to the way Medicare Advantage insurers will be paid will result in about a 3% reduction in payments to Medicare Advantage insurers in 2024. But the agency said that other modifications to the Medicare Advantage program would offset that reduction and yield a 1% increase in spending per person in 2024.

An insurers’Ìýlobbying group saidÌýCMS did not provide adequate information about how it arrived at the 1% figure. “Consequently, there is no way to validate the accuracy” of that estimate, a spokesperson said.

The proposed 2024 adjustments are not a cut, but are part of “the routine annual process of implementing the law as far as how Medicare Advantage plans are paid,” USC’sÌýGinsburg said.Ìý

Our Ruling

Cotton said, “It’s President Biden who is proposing to cut Medicare Advantage.”

Experts said Cotton likely was referring to a recent rule change that allows the government to recover overpayments to insurers and is expected to reduce insurers’Ìýprofits. Those companies might, in turn, raise enrollees’Ìýout-of-pocket costs or reduce benefits. It is unclear whether that will happen.Ìý

Another proposed change, an annual update to the rates paid to Medicare Advantage insurers, will reduce payments to insurers. But reductions will be offset by other changes that are expected to yield a 1% increase in payments to insurers per person in 2024.Ìý

Experts say it’s inaccurate to characterize the changes as a “cut” to Medicare Advantage. We rate it False.

PolitiFact researcher Caryn Baird contributed to this report.

Sources

Ìýby Sen. Tom Cotton, Feb. 6, 2023

Federal Register,Ìý“,” Feb. 1, 2023Ìý

The New York Times,Ìý“, Jan. 30, 2023

Avalere,Ìý“,” Aug. 23, 2022

Axios,Ìý“,” Jan. 30, 2023

KHN,Ìý“CMS Signals That Medicare Advantage Payments Will Decline in 2024,” Feb. 2, 2023Ìý

KFF,Ìý“,” Nov. 10, 2022

KFF,Ìý“,” Jan. 19, 2023

Stat,Ìý“,” Feb. 1, 2023

Fierce Healthcare,Ìý“,” Oct. 29, 2018

Centers for Medicare &ÌýMedicaid Services,Ìý“,” accessed Feb. 9, 2023

NPR,Ìý“,” Nov. 21, 2022

KHN,Ìý“Medicare Failed to Recover up to $125 Million in Overpayments, Records Show,” Jan. 6, 2017

Fierce Healthcare,Ìý“,” Jan. 30, 2023

Interview with Joseph Antos, senior fellow and Wilson H. Taylor scholar in health care and retirement policy at the American Enterprise Institute, Feb. 9, 2023

Interview with Matthew Fiedler, senior fellow with the University of Southern California-Brookings Schaeffer Initiative for Health Policy, Feb. 9, 2023

Statement fromÌý Kamara Jones, U.S. Department of Health and Human Services spokesperson, Feb. 9, 2023

Interview with Jeannie Fuglesten Biniek, associate director of the Program for Medicare policy at KFF, Feb. 9, 2023

Interview with Bowen Garrett, senior fellow in the Health Policy Center at the Urban Institute, Feb. 9, 2023

Interview with Paul Ginsburg, senior fellow at the University of Southern California Schaeffer Center for Health Policy and Economics and a professor of health policy at the University of Southern California Price School of Public Policy, Feb. 9, 2023

Centers for Public Integrity,Ìý“,” Aug. 29, 2016

Assistant Secretary for Planning and Evaluation,Ìý“,” published March 2022Ìý

KFF,Ìý“,” March 23, 2021

Centers for Medicare &ÌýMedicaid Services,Ìý“,” Jan. 30, 2023

Centers for Medicare &ÌýMedicaid Services,Ìý“,” Feb. 1, 2023

Centers for Medicare &ÌýMedicaid Services,Ìý“” published April 2015

Medicare.gov,Ìý“,” accessed Feb. 14, 2023

Social Security Administration, Social Security Act:Ìý, accessed Feb. 14, 2023

Social Security Administration, Social Security Act:Ìý“, accessed Feb. 14, 2023

Social Security Administration,ÌýSocial Security Act: “, accessed Feb. 14, 2023

Politico,Ìý“,” Feb. 8, 2023

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Florida Republican Gov. Ron DeSantis, on Jan. 17, 2023, during a press conference

As he proposed to extend the state’s ban on mandates for covid vaccines and face masks, Florida Republican Gov. Ron DeSantis lobbed a flurry of criticism at President Joe Biden and “the medical establishment.”Ìý

“They were not following the science,” DeSantis said at a Jan. 17ÌýÌýin Panama City Beach. “Almost every study now has said with these new boosters, you’re more likely to get infected with the bivalent booster.”

Fewer than 11% of eligible Floridians have received an updated booster vaccine, according to the .Ìý

The bivalent booster, which contains components of the original covid virus and the omicron variant, is designedÌýÌýbroad protection against illness or hospitalization from those covid strains.Ìý

Research into the efficacy of the bivalent booster in preventing infection continues.Ìý

Broadly speaking, covid vaccines do not prevent infection; they prevent the virus from spreading within the body and causing severe illness, according to . Early that people who got the booster were 84% less likely to be hospitalized from covid.

The data collected on the booster’s ability to curb infection is early and limited. Some clinical trialsÌýÌýthat bivalent shots are no more equipped to prevent people from contracting covid than the original vaccines.Ìý

Although some people have suggested the bivalent booster offers little protection against infection, DeSantis went further. He said people who received the bivalent booster shot were more susceptible to covid than those who hadn’t.

The governor’s press office responded to PolitiFact’s inquiry about the claim, citing two articles and three studies, two of which are not yet peer-reviewed. The most recent came from theÌýCleveland Clinic and was discussedÌýinÌýanÌýÌýin The Wall Street Journal.

Dr. Nabin Shrestha, an infectious-disease physician and one of the study’s authors, told PolitiFact the data did not find a link between the bivalent shot and a higher risk of contracting covid. The early conclusion was the opposite of what DeSantis said: The dose is, in fact, effective in preventing infection.

DeSantis’ Conclusion Could Not Be Drawn From That Study

Cleveland Clinic researchers examined the bivalent booster’s effectiveness in preventing infection among 51,011 health care workersÌý— some of whom had not received the booster — from September to December 2022. Pfizer and Moderna offer the bivalent booster, which the FDA authorized in August.Ìý

Over those four months, about 5% of the clinic’s employees contracted covid. The researchers then estimated that the bivalent booster was about 30% effective in reducing the likelihood of contracting the virus.Ìý

The Cleveland Clinic researchers were not trying to determine the bivalent vaccine’s effectiveness in preventing severe illness or hospitalization.Ìý

“The study wasn’t measuring the vaccine causing infection,” said Jill Roberts, a public health professor at the University of South Florida. “The study was measuring the efficacy of the bivalent vaccine in preventing infection.”

What drove coverage in outlets like The Wall Street Journal was an “unexpected” association researchers found between the number of prior vaccine doses and an increased risk of contracting covid. People with three or more doses of the vaccine had a higher chance of getting infected.Ìý

That finding quickly overshadowed the protection the bivalent shot provided. The Wall Street Journal opinion piece cited the Cleveland Clinic’s study as evidence that vaccine boosters are making “the population as a whole” more vulnerable to covid.Ìý

Andrea Pacetti, the Cleveland Clinic’s public and media relations director, told PolitiFact that the study population, whose average age was 42, is not reflective of the general public.Ìý

“The study was done in a younger, relatively healthy, health care employee population. It included no children, very few elderly individuals and likely few immunocompromised individuals,” Pacetti said. “Therefore, we urge caution in generalizing the findings to the public, which can include different populations.”Ìý

More than 50% of the health care workers participating in the clinic’s study had received three or more doses of a covid vaccine; only 12% were not vaccinated.Ìý

Dr. René Najera, an epidemiologist and director of the Center for Public Health at the College of Physicians of Philadelphia, said the Cleveland Clinic study’s outcome was unsurprising given the characteristics of the research subjects — mostly vaccinated health care workers.

If the majority of the study population received three or more doses of a covid vaccine, for instance, then it is reasonable to assume that the majority of covid cases would occur in that population.

“Those who were studied were health care workers: more likely to be exposed, more likely to be vaccinated as well,” Najera told PolitiFact. “If the study is found to be sound through peer review, its findings would only be applicable to health care workers in large settings such as the Cleveland Clinic, not the general public.”

Pacetti further emphasized that the study has not yet been peer-reviewed, and “more research is needed to either confirm or refute this finding.”Ìý

The Cleveland Clinic acknowledged that two other studies had found a similar association between the number of prior vaccine doses and an increased risk of contracting covid, though it had similar limitations.Ìý

Ìýhad not yet been peer-reviewed, andÌýÌýexamined only health care employees. And even with that finding, the Cleveland Clinic’s study did not suggest the bivalent booster increased the likelihood of infection.Ìý

DeSantis’ “statement is incorrect,” Najera said. “That conclusion cannot be drawn from that study, and the authors state that it is not designed to evaluate that association.”Ìý

Our Ruling

DeSantis said, “Almost every study now has said with these new boosters, you’re more likely to get infected with the bivalent booster.”

An unpublished study from the Cleveland Clinic examined the bivalent covid booster’s effectiveness in preventing infection among a group of about 50,000 health care workers.Ìý

However, one of the study’s authors told PolitiFact that the research did not find an association with the bivalent booster and a higher risk of covid. The study found that the bivalent booster is 30% effective in preventing infection from the virus.

The researchers did find that there could be an association between the number of prior vaccine doses and an increased risk of contracting covid. Still, that finding did not suggest the bivalent booster could cause infection or increase the likelihood of infection.Ìý

We rate DeSantis’Ìýclaim False.

Our Sources

Gov. Ron DeSantis’ Rumble,Ìý“,” Jan. 17, 2023

Cleveland Clinic,Ìý“,” accessed Jan. 19, 2023

Email interview with Bryan Griffin, press secretary for Gov. Ron DeSantis, Jan. 19, 2023

Email interview withÌýJill Roberts, professor of public health at the University of South Florida, Jan. 19, 2023

Email interview with Dr. René Najera, an epidemiologist and director of the Center for Public Health at the College of Physicians of Philadelphia, Jan. 19, 2023

Email interview with Andrea Pacetti, director of public and media relations for the Cleveland Clinic, Jan. 19, 2023

The Washington Post,Ìý“,” Jan. 6, 2023

U.S. Centers for Disease Control and Prevention,Ìý, accessed Jan. 19, 2023

U.S. Centers for Disease Control and Prevention,Ìý“,” Jan. 20, 2023

The Wall Street Journal,Ìý“” Jan. 1, 2023

U.S. Food and Drug Administration,Ìý“,” accessed Jan. 19, 2023

The Lancet,Ìý“,” accessed Jan. 19, 2023

Tampa Bay Times,Ìý“,” Jan. 17, 2023

PolitiFact,Ìý“” Sept. 13, 2022

MedRxiv,Ìý“,” accessed Jan. 19, 2023

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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The Florida Board of Medicine voted Nov. 4 toÌýÌýthat barred physicians from performing surgical procedures on minors to alter “primary or secondary sexual characteristics” and from prescribing them medication to suppress puberty and hormones. The rule included an exception for patients who were already receiving those treatments.Ìý

Two days later, Florida’s Republican governor, Ron DeSantis, said gender-affirming care is “an example of ideology overtaking the practice of medicine,” touting that he worked with the board to take a stand against it.Ìý

“Over 80% of the dysphoria amongst teenagers resolves itself by the time they become older,” DeSantis said during a Nov. 6 campaign event. “So why are you mutilating their body parts?”

Earlier in the year, the Florida Department of Health used the statistic as itÌýÌýmedical transitioning for minors. The department’s April memo said that “80% of those seeking clinical care will lose their desire to identify with the non-birth sex.”Ìý

Dr.Ìý, a Tampa anesthesiologist and member of the governor-appointed board, said heÌýÌýbecauseÌýa “significant percentage” of transgender children will return to their assigned sex.

PolitiFact consulted with experts and data to determine whether gender incongruence will “resolve itself” for a large cohort of teenagers.

Those experts said Florida mischaracterized a statistic linked to an academic review from 2016. What’s more, one of the researchers whose work is cited as the statistic’s source has said the data he consulted is not “optimal” and can lead to “wrong inferences.”

The public comment period for the rule ended Dec. 5.

The 80% figure comes from published in the International Review of Psychiatry.

Dutch health psychologistÌýÌýand Italian psychologist Jiska Ristori examined past studies on gender dysphoria, which describes the distress people may experience because of a discrepancy between their gender identity and the sex assigned to them at birth.

Not all transgender people experience or are diagnosed with gender dysphoria. Gender dysphoria diagnoses focus on gender identity-related psychological distress, not gender identity itself.

The researchers wanted to know whether people who experienced gender dysphoria as children still had it later in life. They looked at the outcomes for children involved with 10 studies conducted from 1968 to 2012 in the U.S., Canada, and the Netherlands.

Their review of the studies said they showed that gender dysphoric feelings went away for 85% of children “around or after puberty” — while acknowledging several limitations.

“There may be a number of arguments to nuance this high percentage of desistence,” the . “The lower persistence rates in the earlier studies, compared to the more recent studies after 2000, may be the result of the inclusion of less extreme cases in the earlier studies than in later studies.”

In other contexts, “desistence” can refer to an apparent end of gender variance and a return to an identity that aligns with the sex assigned at birth. In the paper, the researchers meant the lifting of dysphoric feelings.

Other experts mentioned concerns with the methodology of studies cited in the paper.

Dr. Kristin Dayton, a pediatric endocrinologist, said the studies had a small share of children assigned female at birth — and are thus not representative samples of the population. Eight of the 10 studies examined only children assigned male at birth.

At least six of the studies were conducted before the American Psychiatric Association developed a formal diagnosis for gender dysphoria in children. Some of the 10 studies did not include children who were referred to the studies by medical professionals.

AÌý, for instance, used advertisements to recruit children. Only 30% of the children examined had “frequently” stated a desire to be a girl. Experts said most of the children in that study wouldn’t have met the current criteria for gender dysphoria.

The for the condition include a “marked incongruence” between one’s experienced gender and assigned sex at birth lasting at least six months and a “strong desire to be of the other gender or an insistence that one is the other gender.”

Florida’s Department of Health and Board of Medicine misrepresented the review’s conclusion by stating 80% of children will “lose the desire” to identify with a sex not assigned at birth.

The 80% figure in the reviewÌýÌýchildren’s gender identities; it centered on the persistence and desistence of gender dysphoria in adulthood. SteensmaÌýÌýthat “using the term desistence in this way does not imply anything about the identity of the desisters.”

Although the review noted the studies found that gender dysphoria in childhood is “strongly associated” with a “lesbian, gay, or bisexual outcome,” it did not say what percentage of people studied stopped identifying as transgender.

“The 80% statistic, used by the Florida Department of Health and the state’s leadership, is categorically false,” Dr. Meredithe McNamara, an assistant professor of pediatrics at the Yale School of Medicine, told PolitiFact. “After a close read of the scholarship cited by the state, the state’s conclusion simply cannot be drawn in good faith.”

Steensma, who did not respond to PolitiFact’s requests for an interview, has responded toÌýÌýabout how his research is used to discourage social and medical affirmation for gender diverse adolescents.Ìý

“We want to stress that we do not consider the methodology used in our studies as optimal … or that the terminology used in our communications is always ideal,”ÌýSteensmaÌý. “As shown, it may lead to confusion and wrong inferences.”Ìý

McNamara also said that Florida’s reliance on a 2016 paper is a “glaring problem” because the state neglected to consider about six years of new research.

AÌý, for instance, sought to develop an estimate of transgender children who later stop identifying with a gender that is incongruent with their assigned sex. It evaluated 300 transgender children over five years. To participate in the study, children must have already begun social transitioning, which often involves changing names, haircuts, and pronouns.Ìý

Researchers from Princeton University’s TransYouth Project followed up with participants in person and online. At the end of the five years, 94% of participants still identified as transgender.

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