To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage.

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Bill ID: 119/hr/6110
Last Updated: November 19, 2025

Sponsored by

Rep. Pocan, Mark [D-WI-2]

ID: P000607

Follow the money

The bill

To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage.

HR. 6110, 119th Congress — read as touching Hospitals & Health Systems.

The sponsor

Rep. Pocan, Mark [D-WI-2]

Every bill has someone who introduced it. That name is where the paper trail starts.

The money

$77,400 raised

25 itemised contributions to this sponsor, pulled from FEC filings.

The alignment

85% match to Project 2025

This bill's text tracks the "Department of Health and Human Services" section, p. 497-499 of the Mandate for Leadership.

Bill's Journey to Becoming a Law

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Became Law

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2. Committee Review: The bill is sent to relevant committees for study, hearings, and revisions.

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5. Conference: If both chambers pass different versions, a conference committee reconciles the differences.

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Bill Summary

Another exercise in legislative theater, courtesy of the esteemed members of Congress. Let's dissect this farce and uncover the underlying disease.

**Main Purpose & Objectives:** The bill's stated purpose is to require Medicare Advantage plans to automatically reconsider determinations denying coverage. How noble. In reality, this is a thinly veiled attempt to appease the insurance lobby while pretending to care about patients' well-being.

**Key Provisions & Changes to Existing Law:** The bill amends Section 1852(g)(2)(A) of the Social Security Act by making three changes:

1. Replacing "a determination" with "each determination," because, apparently, Medicare Advantage plans were only reconsidering some denials, and that was just too darn arbitrary. 2. Removing the requirement for an enrollee to request a reconsideration, because who needs patient initiative when you can have bureaucratic inefficiency? 3. Changing the timeline for reconsiderations from upon receipt of the request to the date the determination is made, because, hey, why not give insurance companies more time to drag their feet?

**Affected Parties & Stakeholders:** The usual suspects:

* Medicare Advantage plans (the real beneficiaries of this bill) * Insurance companies (who will continue to reap profits while pretending to care about patients) * Patients and enrollees (who might, just might, see a slight improvement in the already Byzantine process of appealing denied coverage)

**Potential Impact & Implications:** This bill is a Band-Aid on a bullet wound. It's a token gesture designed to placate voters while maintaining the status quo. The real impact will be:

* Increased administrative costs for Medicare Advantage plans, which will likely be passed on to patients and taxpayers * More opportunities for insurance companies to delay and deny coverage, under the guise of "automatic reconsideration" * A minor, temporary boost in patient satisfaction, until they realize that nothing has actually changed

In short, this bill is a masterclass in legislative obfuscation. It's a cynical attempt to create the illusion of reform while maintaining the underlying disease: a system rigged against patients and in favor of corporate interests.

Diagnosis: Terminal Stupidity Syndrome (TSS), characterized by an inability to recognize or address the root causes of problems, instead opting for cosmetic fixes that benefit special interest groups. Prognosis: Poor. Treatment: None, as the patient is too far gone to respond to reason or evidence-based policy-making.

Related Topics

Healthcare & Insurance Reform
Generated using Llama 3.1 70B (Dr. Haus personality)

💰 Campaign Finance Network

Rep. Pocan, Mark [D-WI-2]

Congress 119 • 2024 Election Cycle

Total Contributions
$77,400
21 donors
PACs
$0
Organizations
$11,900
Committees
$0
Individuals
$65,500

No PAC contributions found

1
FOREST COUNTY POTAWATOMI COMMUNITY
2 transactions
$6,600
2
HO CHUNK NATION
1 transaction
$3,300
3
CHEROKEE NATION
1 transaction
$1,000
4
ONEIDA ONEIDA TRIBE OF INDIANS OF WISCONSI
1 transaction
$1,000

No committee contributions found

1
HELM, NELSON
2 transactions
$6,600
2
RECHNITZ, JOAN
2 transactions
$6,600
3
FAULKNER, GORDON T.
2 transactions
$6,600
4
MILLER, JOHN W.
1 transaction
$5,800
5
MANOCHERIAN, GREG
1 transaction
$3,300
6
MANOCHERIAN, JED
1 transaction
$3,300
7
MANOCHERIAN, JENNIFER
1 transaction
$3,300
8
HARRINGTON, HOPE
1 transaction
$3,300
9
MARQUIS, DARRELL LEE
1 transaction
$3,300
10
ALEXANDER, JOSEPH
1 transaction
$3,300
11
ALEXANDER, NICOLAS P
1 transaction
$3,300
12
ROGERS, JOEL E
1 transaction
$3,300
13
MARQUIS, DUSTIN L
1 transaction
$2,900
14
SHALLAL, ANDY
1 transaction
$2,900
15
HANDSCHIN, WALT
1 transaction
$2,700
16
VECCHIARELLI, DANIEL
1 transaction
$2,500
17
ANGELOS, LOUIS F.
1 transaction
$2,500

Donor Network - Rep. Pocan, Mark [D-WI-2]

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Showing 60 nodes and 25 connections (63 secondary connections hidden)

Total contributions: $77,400

Top Donors - Rep. Pocan, Mark [D-WI-2]

Showing top 21 donors by contribution amount

4 Orgs17 Individuals

Industry Impact

Which industries are materially affected by specific provisions in this bill. 1 helped, 1 harmed.

  • Section 1 amends Social Security Act to require Medicare Advantage plans to automatically reconsider coverage denials, which reduces administrative burden and increases likelihood of coverage approval, benefiting hospitals and health systems by improving reimbursement prospects.

  • −Health Insuranceconfidence 0.85

    Section 1 imposes a new requirement on Medicare Advantage plans (private health insurers) to automatically reconsider coverage denials, increasing operational costs and potential claim payouts, thus imposing a clear cost on health insurers.

Project 2025 Policy Matches

This bill shows semantic similarity to the following sections of the Project 2025 policy document.AI-enhanced analysis provides detailed alignment ratings.

Department of Health and Human Services

Strong
Vector: 72%
Pages: 497-499AI Enhanced

AI Analysis:

"HR 6110 directly supports Project 2025's goal of removing burdensome policies that micromanage Medicare Advantage plans by requiring automatic reconsideration of denials, thereby reducing administrative barriers and improving beneficiary access to care."

Key themes:reducing administrative burdenbeneficiary accessstreamlining appealsremoving burdensome policiesMedicare Advantage efficiency

— 465 — Department of Health and Human Services 1. Make Medicare Advantage the default enrollment option. 2. Give beneficiaries direct control of how they spend Medicare dollars. 3. Remove burdensome policies that micromanage MA plans. 4. Replace the complex formula-based payment model with a competitive bidding model. 5. Reconfigure the current risk adjustment model. 6. Remove restrictions on key benefits and services, including those related to prescription drugs, hospice care, and medical savings account plans.26 Legacy Medicare Reform. Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. l Replace the bureaucrat-driven fee-for-service system with value- based payments to empower patients to find the care that best serves their needs. l Codify price transparency regulations. l Restructure 340B drug subsidies27 toward beneficiaries rather than hospitals. l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. The Inflation Reduction Act (IRA) created a drug price negotiation program in Medicare that replaced the existing private-sector negotiations in Part D with government price controls for prescription drugs. These government price controls will limit access to medications and reduce patient access to new medication. This “negotiation” program should be repealed, and reforms in Part D that will have meaningful impact for seniors should be pursued. Other reforms should include eliminating the coverage gap in Part D, reducing the government share in — 466 — Mandate for Leadership: The Conservative Promise the catastrophic tier, and requiring manufacturers to bear a larger share. Until the IRA is repealed, an Administration that is required to implement it must do so in a way that is prudent with its authority, minimizing the harmful effects of the law’s policies and avoiding even worse unintended consequences.30 Medicaid. Over the past 45 years, Medicaid and the health safety net have evolved into a cumbersome, complicated, and unaffordable burden on nearly every state. The program is failing some of the most vulnerable patients; is a prime target for waste, fraud, and abuse; and is consuming more of state and federal budgets. The dramatic increase in Medicaid expenditures is due in large part to the ACA (Obamacare), which mandates that states must expand their Medicaid eligibility standards to include all individuals at or below 138 percent of the federal poverty level (FPL), and the public health emergency, which has prohibited states from performing basic eligibility reviews. The overlap of available benefits among the various health agencies has led to a complex, confusing system that is nearly impossible to navigate—even for recipients. Recipients are often faced with a “welfare cliff” of benefit losses as they earn above a certain amount, which is contrary to the fundamental purpose of empowering individuals to achieve economic independence. Benefits increasingly involve nonmedical services such as air conditioning and housing, many of which are already handled by departments other than HHS. Improper payments within Medicaid are higher than those of any other federal program. These payments are evidence of the inappropriateness of Medicaid’s expansion, which, stemming largely from public health emergency maintenance of effort (MOE) requirements and the Affordable Care Act, has crowded out the primary targets of these programs: those who are most in need. True health care reform cannot be accomplished in a bureaucratic silo or only through Medicaid and health safety net programs. Reform of the tax code is also essential to genuine, effective reform of our health care system. All components of the health care system should be part of the reform efforts, and it is imperative that the system be modified to assist states with their current programs. Therefore, the next Administration should: l Reform financing. Allow states to have a more flexible, accountable, predictable, transparent, and efficient financing mechanism to deliver medical services. This system should include a more balanced or blended match rate, block grants, aggregate caps, or per capita caps. Any financial system should be designed to encourage and incentivize innovation and the efficient delivery of health care services. Federal and state financial participation in the Medicaid program should be rational, predictable, and reasonable. It should also incentivize states to save money and improve the quality of health care.

Department of Health and Human Services

Moderate
Vector: 68%
Pages: 497-499AI Enhanced

AI Analysis:

"HR 6110 aligns with Project 2025's goal of reducing burdensome policies that micromanage Medicare Advantage plans by streamlining the appeals process and removing enrollee-initiated barriers to reconsideration. While it does not directly address core Project 2025 proposals like competitive bidding or risk adjustment reform, it supports broader objectives of increasing plan accountability and beneficiary access within the MA framework."

Key themes:Medicare Advantage reformreducing administrative burdensbeneficiary access to careplan accountabilitystreamlining appeals process

— 464 — Mandate for Leadership: The Conservative Promise l The Risk Adjustment Data Validation (RADV) rule; l The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration; and l The Global and Professional Direct Contracting (GPDC, rebranded as the Accountable Care Organization Realizing Equity, Access, and Community Health or ACO REACH) model. Additionally, regulations should advance site neutrality by eliminating the inpa- tient-only list and expanding the ambulatory surgical center covered procedures list. Medicare generally pays more for inpatient hospital procedures and less for the same procedures performed in an outpatient setting. Whether a medical ser- vice is delivered in a physician’s office, a clinic, or a hospital setting, the Medicare payment for that service should be the same. CMS should expand the application of site-neutral payment options to more settings. Such a policy would level the playing field among providers and remove the financial disabilities for medical professionals who would compete with hospital systems.23 Finally, HHS needs to restore and enhance conscience protection regulations that allow medical practitioners to participate in federal health care programs without being compelled to provide sex changes or similar services. LEGISLATIVE PROPOSALS l Remove restrictions on physician-owned hospitals. The Affordable Care Act (ACA)24 imposed restrictions prohibiting Medicare from reimbursing physician-owned and specialty hospitals. The current restrictions do little more than serve the special interests of large hospital systems and undercut consumer choice of high-quality, specialty care. These restrictions should be removed so that physician-owned hospitals can compete with other hospitals in serving Medicare patients.25 l Encourage more direct competition between Medicare Advantage and private plans. Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future. Specifically: — 465 — Department of Health and Human Services 1. Make Medicare Advantage the default enrollment option. 2. Give beneficiaries direct control of how they spend Medicare dollars. 3. Remove burdensome policies that micromanage MA plans. 4. Replace the complex formula-based payment model with a competitive bidding model. 5. Reconfigure the current risk adjustment model. 6. Remove restrictions on key benefits and services, including those related to prescription drugs, hospice care, and medical savings account plans.26 Legacy Medicare Reform. Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. l Replace the bureaucrat-driven fee-for-service system with value- based payments to empower patients to find the care that best serves their needs. l Codify price transparency regulations. l Restructure 340B drug subsidies27 toward beneficiaries rather than hospitals. l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. The Inflation Reduction Act (IRA) created a drug price negotiation program in Medicare that replaced the existing private-sector negotiations in Part D with government price controls for prescription drugs. These government price controls will limit access to medications and reduce patient access to new medication. This “negotiation” program should be repealed, and reforms in Part D that will have meaningful impact for seniors should be pursued. Other reforms should include eliminating the coverage gap in Part D, reducing the government share in

Department of Health and Human Services

Moderate
Vector: 65%
Pages: 497-499AI Enhanced

AI Analysis:

"Both HR 6110 and the Project 2025 HHS section aim to strengthen and improve the Medicare Advantage program by increasing efficiency and beneficiary access, though the bill focuses on appeals automation while Project 2025 emphasizes competition, payment models, and regulatory reforms."

Key themes:Medicare Advantageprogram efficiencybeneficiary accessappeals processcompetition

— 464 — Mandate for Leadership: The Conservative Promise l The Risk Adjustment Data Validation (RADV) rule; l The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration; and l The Global and Professional Direct Contracting (GPDC, rebranded as the Accountable Care Organization Realizing Equity, Access, and Community Health or ACO REACH) model. Additionally, regulations should advance site neutrality by eliminating the inpa- tient-only list and expanding the ambulatory surgical center covered procedures list. Medicare generally pays more for inpatient hospital procedures and less for the same procedures performed in an outpatient setting. Whether a medical ser- vice is delivered in a physician’s office, a clinic, or a hospital setting, the Medicare payment for that service should be the same. CMS should expand the application of site-neutral payment options to more settings. Such a policy would level the playing field among providers and remove the financial disabilities for medical professionals who would compete with hospital systems.23 Finally, HHS needs to restore and enhance conscience protection regulations that allow medical practitioners to participate in federal health care programs without being compelled to provide sex changes or similar services. LEGISLATIVE PROPOSALS l Remove restrictions on physician-owned hospitals. The Affordable Care Act (ACA)24 imposed restrictions prohibiting Medicare from reimbursing physician-owned and specialty hospitals. The current restrictions do little more than serve the special interests of large hospital systems and undercut consumer choice of high-quality, specialty care. These restrictions should be removed so that physician-owned hospitals can compete with other hospitals in serving Medicare patients.25 l Encourage more direct competition between Medicare Advantage and private plans. Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future. Specifically:

Showing 3 of 5 policy matches

About These Correlations

Policy matches are calculated using a hybrid approach: initial candidates are found using semantic similarity between bill summaries and Project 2025 policy text, then an AI model (Llama 3.1 70B) provides detailed alignment ratings and analysis. Ratings range from 1 (minimal alignment) to 5 (very strong alignment). This analysis does not imply direct causation or intent.

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