Originally by Richard Eisenberg at fortune.com
President-elect Donald Trump has nominated heart surgeon Dr. Mehmet Oz to run Medicare and Medicaid, the massive government programs providing health care to 150 million Americans. What could that mean if you’re on Medicare or will enroll in coming years?
While no one knows for sure, and Oz would need Senate confirmation to become the 19th Administrator of the Centers for Medicare and Medicaid Services (CMS), it’s possible to read the tea leaves based on what we’ve heard from him, Trump, and Robert F. Kennedy Jr.—Oz’s boss if confirmed by the Senate to run the Department of Health and Human Services.
Trump and Oz have been friends for 20 years and Oz served on Trump’s Council on Sports, Fitness, and Nutrition in his first term.
In a statement nominating America’s most famous TV doctor talk-show host to work with Kennedy and “take on the illness industrial complex,” Trump wrote: “There may be no Physician more qualified and capable than Dr. Oz to Make America Healthy Again.”
But, STAT News reporter Lev Facher told PBS, Kennedy and Oz “are about as outside the mainstream as you could conceive of for picks to run the Health department and the Centers for Medicare and Medicaid Services.”
Speaking at the Gerontological Society of America (GSA) conference in Seattle last week before Trump selected Oz, Andrew MacPherson, managing partner of the nonpartisan health care consulting firm Healthsperien, said: “With the Trump administration, federal health insurance programs will be under extraordinary scrutiny.”
During his 2024 presidential campaign, Trump said “he will not cut one penny from Medicare.” The 2024 GOP platform language said Republicans would “protect Medicare and ensure Seniors receive the care they need without being burdened by excessive costs.”
But that doesn’t mean Medicare won’t change during Trump’s second term.
As you might expect, some Republicans in Congress have heartily endorsed Oz and some Democrats have said he shouldn’t get the CMS post.
Here’s a rundown on what you might expect from Dr. Oz (who lost his bid to be a Republican Senator from Pennsylvania in 2022) if he runs Medicare, Medicaid and management of the Affordable Care Act at the 6,000-person CMS, as well as what’s impossible to know:
Pushing Medicare Advantage plans
Medicare beneficiaries can choose between Traditional Medicare (Parts A and B, also called Original Medicare) and private insurers’ Medicare Advantage plans (Part C). Currently, 54% are in Medicare Advantage plans.
Medicare experts expect Oz and the President will push those plans, favoring them over Traditional Medicare.
Oz has a history of endorsing Medicare Advantage. When he ran for Senate and AARP asked how he would strengthen Medicare, Oz said: “We can expand Medicare Advantage plans. These plans are popular among seniors, consistently provide quality care and have a needed incentive to keep costs low.”
On an episode of The Dr. Oz show, he and a Medicare Advantage agent talked up purchasing a policy. “Millions are doing it; so can you,” Oz said.
Trump and Oz might try to make Medicare Advantage plans the default choice for Medicare beneficiaries, as the Project 2025 report recommended.
“I think there will be a conversation around that,” MacPherson said.
Unclear, however, is whether Oz would halt the scheduled 2026 rule requiring Medicare Advantage plans to provide members with prior authorization results quickly.
Bob Blancato, an elder advocate, said at the GSA conference: “We need to keep an eye on Medicare Advantage, the partial privatization of Medicare.”
In 2020, Oz co-wrote an article calling for a Medicare Advantage for All system they dubbed “Medical Advantage.”
It would mean every American except for those on Medicaid (the state-federal health program for low-income Americans) would sign up to buy government-run health insurance sold by insurance companies—not just people 65 and older.
This new Medicare Advantage program would be funded through a 20% payroll tax, half paid by employers and half by employees. The policies would have a $1,000 annual deductible. Traditional Medicare in 2025 has a $257 Part B deductible and a $1,676 Part A deductible for in-patient hospital services.
The Medical Advantage coverage, Oz said, would be much better than what’s currently available to most people.
Searching for Medicare waste and fraud
When Trump made his CMS nomination announcement, he said Oz “will also cut waste and fraud within our Country’s most expensive Government Agency, which is a third of the Nation’s Healthcare spend, and a quarter of our entire National Budget.”
There seems to be plenty of waste, and possibly fraud, for Oz to try eliminating from Medicare and Medicaid.
An April 2024 U.S. Government Accountability Office (GAO) said the two programs “are susceptible to payment errors—over $100 billion in 2023.” These “improper payments” were either incorrect amounts or shouldn’t have been made at all, the GAO said.
Medicare spent $1.0 trillion in 2023 to provide health care services for roughly 66 million Americans; Medicaid accounted for $849 billion in federal and state spending to about 90 million people.
If Oz and Trump can cut waste and fraud in a dramatic way, that could help keep Medicare afloat.
The program’s Hospital Trust Fund is expected to have serious solvency problems in 2036, which worries Americans. In a recent NerdWallet survey, 74% of respondents with Medicare said they were concerned about their benefits being reduced in their lifetime.
The 2024 Republican platform said the part would “strengthen Medicare for future generations,” but didn’t say how.
Hands off Medicare’s $2,000 cap on drug costs
The Biden administration’s Inflation Reduction Act lowered to $2,000 Medicare beneficiaries’ maximum annual out-of-pocket cost for prescription drugs covered by their plans and experts think Oz won’t try to raise that cap.
Although Project 2025 called for the repeal of the Inflation Reduction Act, “nobody’s going to mess with the $2,000 cap,” said Blancato at the GSA conference before Oz was nominated.
Restraining prescription drug prices
Oz and Trump have said they want to make prescription drugs more affordable. While running for Senate, Oz told AARP: “Cumbersome regulations in Washington worsen high prescription drug costs. We can accelerate clinical studies on newly developed drugs to reduce wasted time and money on ineffective products. This will also improve efficiency, so life-improving medications can reach seniors earlier and at reduced prices.”
But it’s unclear whether Oz and Trump would continue or expand the Inflation Reduction Act’s program letting Medicare negotiate prices with pharmaceutical companies.
“Trump has talked about negotiating drug prices. Maybe he’ll change the number of drugs that can be negotiated, but he won’t repeal this,” Blancato said.
Ending nursing home staffing rules
As part of his CMS job, Oz will oversee the nation’s nursing homes. Some think he may eliminate the new federal nursing-home staffing standards the Biden administration initiated, allowing nursing home operators to make their own staffing choices.
Trimming Medicaid
Medicaid provides, among other things, long-term care coverage for people in the program. Experts believe Oz and Trump will look for ways to cut the cost of Medicaid.
This could be done by changing the rules on who qualifies for benefits (such as instituting a work requirement to receive them) or moving Medicaid funding to local block grants.
Tinkering with the Affordable Care Act
While Oz and Trump aren’t expected to abolish the Affordable Care Act (ACA) and Oz has called it “half-good,” experts expect changes to the program.
“The ACA won’t be repealed and replaced, but the Trump administration will chip away at aspects they don’t like, such as the premium subsidies that expire at the end of 2025,” said MacPherson.
Said Blancato: “Those subsidies are used by 20 million people. If they go after the subsidies, that could mean a 79% premium increase.”
Two unknowns: telehealth and Hospital at Home
There are two areas of Medicare coverage where it’s impossible to know what Oz might do because Congress and the Biden administration need to make decisions about them by year’s end.
The first is whether to continue allowing Medicare coverage nationwide for telehealth visits with doctors. This coverage is due to expire December 31 unless Congress and Biden extend it.
The second is whether Medicare will keep covering hospital at home; this coverage will end December 31, too, unless Congress and the president push back that date.
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