Could changes be coming to Medicare, Medicaid with Dr. Oz leading CMS?

Because President-elect Donald Trump announced former TV host-turned-surgeon Dr. Mehmet Oz. Directed by the Centers for Medicare and Medicaid Services (CMS).questions are swirling about whether changes may be coming to government programs.

If the Senate confirms his nomination, Oz, as CMS administrator, would oversee Medicare, Medicaid and the Children’s Health Insurance Program. At least 145 million Americans are enrolled in one of the three programs, according to federal data.

Oz has previously voiced support for an option that could lead to further privatization of Medicare. Although Oz has not revealed his views on Medicaid, some Republicans in Congress have expressed support for changes that would cut the program’s budget.

Being the default Medicare Advantage

CMS Administers Medicare, the federal health insurance program mostly for those 65 and older. More than 66 million People in the US get coverage through Medicare, the program says.

However, Oz has expressed his support Medicare Advantagea Medicare-approved plan run by private insurance companies. The plan he has to follow the rules Medicare mandates such as limiting out-of-pocket costs and covering all services covered by traditional Medicare.

“Medicare Advantage has definitely become a more important part of the Medicare program. It is now the most popular coverage option program,” Joe Albanese, a senior policy analyst at the right-leaning Paragon Health Institute, told ABC News.

“It’s grown in popularity very quickly in the last decade,” he continued. “And that will change the way the government engages with Medicare and Medicare beneficiaries.”

in one Co-authored opinion piece for Forbes In June 2020, Oz said that Medicare Advantage offers better care because there are competing plans. He said Medicare Advantage could also be extended to all Americans not on Medicaid, which would be funded by a 20% payroll tax. Also He promoted Medicare Advantage on his show, “The Dr. Oz Show.”

Trump has also promoted Medicare Advantage, offering new benefits to seniors who were enrolled in the plan. What’s more, 2025 project – Plan of conservative policy proposals proposed by the Heritage Foundation – Proposed to make Medicare Advantage the default option for Medicare coverage.

“I don’t know what the plan would be for such a proposal in Congress or in this administration,” Albanes said. “I can say that some advocates of a Medicare Advantage default enrollment approach say that (Medicare Advantage) plans are typically able to offer comparable, if not lower, costs.”

However, critics argue that Medicare Advantage should be the default option could privatize the program and limit people’s options for care because many doctors and hospitals do not accept Medicare Advantage.

“To move to a default option, I think that would be difficult to achieve, especially in an administration that favors less regulation (that) Medicare Advantage requires strong cooperation with regulators,” Daniel Polsky, Bloomberg Distinguished Professor. in health economics at Johns Hopkins University, he told ABC News. “A lot of work is being done to ensure that private insurance companies use federal dollars wisely and act in the best interests of the patients they care about.”

If Medicare Advantage became the default option, Polsky said, spending would increase, and the program would not be able to negotiate with as many providers as traditional Medicare.

“You have to take the good and the bad with Medicare Advantage if you’re going to lean on that program,” he said. “There are going to be beneficiaries who are not going to be served by that program because they need specialized care with specialized providers who can’t get into that program.”

Medicaid work requirements

Little is known in Oz about Medicaid, the federal health insurance program for disabled and low-income Americans. CMS It works with state programs to administer Medicaid More than 72.4 million people are enrolled.

Some Republicans have called for cuts to Medicaid it is 9% of the federal budgetAccording to the Peter G. Peterson Foundation.

Senator John Cornyn, Republican of Texas, he proposed the establishment of financial support groupssums of money that the government gives to the states to cover medical expenses. This differs from the current method, in which the government contributes a dollar for every dollar spent by the states.

Polsky said moving to a block grant program would have negative consequences.

“To move to a block grant program, any marginal spending by the states would be felt at a much higher level,” he said. “Medicaid is a really critical countercyclical program, so when we’re in a recession or going into a recession, spending goes up in the Medicaid program, which acts as an important macro balance that would disappear somewhat because states have to balance their budgets.”

He added that the flexibility to increase or decrease spending based on the needs of a given patient population would also be much more difficult if a subsidy program were implemented, which he said could have “negative health consequences.”

Some Republicans may push Oz and the Trump administration to implement it working conditions Being eligible for Medicaid, including working or volunteering for certain hours or participating in educational activities.

House Budget Committee Chairman Jodey Arrington, R-Texas, he told reporters last week That he supports “responsible and reasonable work demands”.

Polsky said it would be a deterrent to people who would otherwise be eligible to sign up for Medicaid, but it doesn’t promote work.

“I know from my own evidence — it appears that they weren’t over-implemented, but there were some work requirements for other programs in the past — that with the work requirements there’s no incentive or … The actual work isn’t increasing for people who sign up for these programs.” , he said.

Polsky said he found in his research that those requirements create more administrative burden due to the additional documentation the new requirements entail.