President-elect Donald Trump has selected renowned heart surgeon Dr. Mehmet Oz to lead Medicare and Medicaid, vital programs for 150 million Americans. What are the implications for current and future Medicare enrollees?
While Dr. Oz awaits Senate confirmation to become the 19th Administrator of the Centers for Medicare and Medicaid Services (CMS), insights can be gathered from statements by Oz, Trump, and Robert F. Kennedy Jr., his prospective superior at the Department of Health and Human Services.
Trump and Oz share a two-decade friendship, with Oz previously serving on Trump’s Council on Sports, Fitness, and Nutrition.
Trump praised Oz, nominating him to help Kennedy “address the illness industrial complex,” claiming: “There may be no Physician more qualified than Dr. Oz to Make America Healthy Again.”
However, Lev Facher of STAT News suggested to PBS that Kennedy and Oz are unconventional choices to lead the health department and CMS.
Speaking at the Gerontological Society of America (GSA) conference prior to the announcement, Andrew MacPherson, of Healthsperien, noted, “Federal health programs under Trump will face high scrutiny.”
Trump’s campaign promised not to cut Medicare, with Republicans aiming to “protect Medicare” and ensure seniors receive necessary care without high costs.
But changes to Medicare during Trump’s tenure cannot be ruled out.
Republicans have largely backed Oz, while Democrats have voiced opposition to his CMS appointment.
Here’s how Dr. Oz might influence Medicare, Medicaid, and the Affordable Care Act if he leads CMS:
Pushing Medicare Advantage plans
Medicare users choose between Traditional Medicare and private Medicare Advantage plans. Currently, 54% opt for Medicare Advantage.
Expect Oz and Trump to favor these plans over Traditional Medicare.
Oz has previously backed Medicare Advantage, labeling it as providing quality care and cost-efficiency.
On The Dr. Oz show, he encouraged seniors to consider these plans.
There is speculation they may push for Medicare Advantage as the default option for beneficiaries.
MacPherson anticipated discussions around this shift.
However, it’s uncertain if Oz would support or stop the 2026 rule requiring timely prior authorization for Medicare Advantage plans.
Bob Blancato at GSA criticized Medicare Advantage as partial privatization of Medicare.
Oz’s 2020 article advocated for a Medicare Advantage for All model, calling it “Medical Advantage.”
Under this, all Americans, except Medicaid enrollees, would obtain government-run health insurance, funded by a 20% payroll tax.
Oz claims this could improve coverage for most people.
Focused on Medicare waste and fraud
Trump noted Oz would target waste and fraud in Medicare and Medicaid, key expenses in the national budget.
The GAO reported over $100 billion in improper payments in 2023.
Medicare spent $1 trillion to serve 66 million Americans; Medicaid cost $849 billion for 90 million people.
Efforts to reduce waste could help sustain Medicare, facing fiscal challenges by 2036.
The 2024 GOP platform aims to “strengthen Medicare,” but specifics remain elusive.
Preserving Medicare’s $2,000 drug cost cap
The $2,000 out-of-pocket drug cost limit, part of Biden’s Inflation Reduction Act, is expected to remain untouched by Oz.
Project 2025 seeks to repeal this Act, but Blancato believes the cap will endure.
Controlling prescription drug prices
Trump and Oz seek affordable drug prices. Oz proposed streamlined drug trials to cut costs and expedite senior access.
Yet, it’s uncertain if they’ll expand the Inflation Reduction Act’s drug price negotiations.
Blancato suggested Trump might adjust the number of negotiable drugs but won’t repeal it.
Rethinking nursing home staffing rules
In his CMS role, Oz may reconsider the Biden-initiated nursing-home staffing regulations, allowing operators more staffing discretion.
Reviewing Medicaid
Expect efforts to reduce Medicaid costs, possibly through eligibility adjustments or block grants.
Adjusting the Affordable Care Act
While the ACA won’t be scrapped, tweaks are anticipated, especially concerning subsidies set to end in 2025.
Blancato warned subsidy cuts could hike premiums by 79%.
Uncertainty in telehealth and Hospital at Home
Two Medicare areas remain uncertain as Congress must decide on telehealth and Hospital at Home coverage extensions by year-end.
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