WASHINGTON — When President-elect Donald Trump picked Dr. Mehmet Oz for a powerful executive branch job overseeing Medicare, incoming Senate Finance Committee Chair Mike Crapo, R-Idaho, quickly praised the TV-famous physician and said he looked forward to considering his coming nomination.
“Far too often, patients relying on federal government health care programs are forced to accept bureaucratic, one-size-fits-all coverage,” Crapo said. “Dr. Oz has been an advocate for providing consumers with the information necessary to make their own health care decisions.”
It turns out that Oz, Trump’s pick to run the Centers for Medicare and Medicaid Services, endorsed something of a one-size-fits-all plan for health care just four years ago.
Oz co-wrote a Forbes piece in June 2020 with former Kaiser Permanente CEO George Halvorson endorsing a “Medicare Advantage for All” system that called for eliminating employer-provided insurance and Affordable Care Act coverage and putting “every American who is not on Medicaid” into Medicare Advantage, which uses private plans to cover enrollees. They proposed to fund it with a 20% payroll tax split between employers and workers.
“It’s perhaps ironic that this proposal to provide universal coverage through private Medicare Advantage plans bears a striking resemblance to Kamala Harris’ ‘Medicare for All’ proposal during the 2020 campaign,” said Larry Levitt, executive vice president for health policy at the nonpartisan research group KFF.
The Harris plan “came back to haunt her politically,” Levitt said. “It’s hard to imagine Republicans broadly embracing a Medicare Advantage-for-all plan that requires a big tax increase and more people covered through a government entitlement program.”
Four years after Oz outlined his Medicare Advantage for All plan, Trump announced his choice to run CMS, promising that Oz would “cut waste and fraud within our Country’s most expensive Government Agency,” without describing how.
Spokespeople for Trump’s transition team didn’t reply to messages seeking comment.
Sen. James Lankford, R-Okla., said he hasn’t reviewed the 2020 Medicare Advantage proposal, but he praised Oz as someone who has “studied these issues a lot.”
“We need somebody to be transformative,” Lankford said. “We want to know: Where is he going? What’s the perspective? Obviously, he needs to answer questions for what he’s done in the past.”
Oz’s evolution on Obamacare and Medicare
Oz’s evolution on health care leaves open the question of how a second Trump administration will overhaul health care after Trump said he had “concepts of a plan” for doing so.
As CMS administrator, Oz would hardly be a free agent; his mission would be to carry out Trump’s vision. But Trump’s lack of specificity about health care could empower Oz to fill in the blanks.
Going back to the Obama era, Oz offered qualified praise for Obamacare for providing a “safety net.” Trump softened his rhetoric attacking Obamacare in the final stretch of his 2024 campaign but still called for replacing it, without explaining how.
By 2022, when he ran for the Senate, Oz had taken a more modest position on health care that didn’t call for upending the system, while he also criticized the Affordable Care Act. Oz said on an AARP questionnaire: “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.”
Some Democrats are deeply concerned about Oz’s running CMS.
“No one should doubt that Dr. Oz and the Trump administration pose a very real threat to Medicare, Medicaid and health coverage as we know it,” said Sen. Patty Murray D-Wash., a senior member of the Health, Education, Labor and Pensions Committee. “Trump notoriously undermined the Affordable Care Act every chance he got and drove health care costs through the roof.”
Senate Finance Committee Chair Ron Wyden, D-Ore., who will become ranking member in January, said the job of CMS administrator is “one of the most consequential in American health care.”
“We’re going to spend $4.5 trillion-plus this year on American health care,” he said. “And a lot of it falls under the kind of frame that he’s going to be reviewing. And I have some real questions.”
Medicare Advantage changes on the horizon?
If Oz is confirmed and chooses to push more people into Medicare Advantage, as he has pitched, he may not have too hard a time. Enrollment has been increasing steadily for several years, so in some ways Medicare is already on the path to privatization, said Tricia Neuman, executive director of the program on Medicare policy at KFF.
Still, Neuman said, Oz would be walking a tightrope to avoid upsetting Medicare enrollees: While Medicare Advantage has grown increasingly popular, surveys show that older adults like having options when they choose coverage.
“In our focus groups, people say they’re satisfied with both traditional Medicare and Medicare Advantage, and they make their choices based on different preferences,” Neuman said.
The push to private plans also might not address the primary concern among patients — the high cost of care, said Arthur Caplan, head of the medical ethics division at NYU Langone Medical Center in New York City.
A report in 2022 from the Commonwealth Fund, a health care think tank, found about 1 in 4 older adults with Medicare reported skipping services, like dental care, because of high costs. A similar share avoided visits with specialists or follow-ups with doctors for the same reason.
“There’s this dream that Republicans have had forever, and he had it when he ran for Senate in Pennsylvania, that the solution to Medicare is privatization, but all that does is get some of the money off the government books,” Caplan said. “It doesn’t really solve the wasteful expenditures that we have in Medicare. Prices are too high, and it doesn’t really give access.”
Wyden said Oz should “expect questions” about practices like “prior authorization” under Medicare Advantage, in which insurance companies determine whether services are medically necessary before they’re used. “There is growing concern among seniors and others who are vulnerable that these insurance companies are getting away with all kinds of razzmatazz to deny coverage that people have paid for,” Wyden said.
Lankford said Medicare Advantage “is not working like it was designed to” as hospitals are “frustrated” and insurers are “denying claims” or “not paying on time.”
Sen. Mike Rounds, R-S.D., said there’s “no such thing as a perfect plan” for health care.
“We’ll be able to ask him questions, but we start out giving the president the benefit of the doubt” on nominees, he said.
How would Trump and Oz handle drug prices?
Another open question is how Trump will handle the popular policy in Democrats’ Inflation Reduction Act to empower Medicare to negotiate drug prices, an idea that many Republicans blast as price fixing and which the GOP unanimously voted against.
“President-elect Trump has not said directly whether he would defend the negotiations provisions in the Inflation Reduction Act or try to pare them back during the campaign,” Neuman said. “It’s not really clear what happens with drug pricing generally or drug negotiations specifically.”
The CMS’ deadline to select the next 15 drugs up for negotiations is in February, although it’s unclear whether the agency will be able to meet the deadline so close to the inauguration, Neuman said.
Oz would most likely need to address Medicaid, too. Some Republicans see the government plan for low-income people as a potential source of funding to pay for Trump’s tax cut extension.
“There’s a lot of children and a lot of disabled in Medicaid, and when you push back what has to be covered, trim benefits eligibility or just leave it to the states, poor states — the Alabamas, the Mississippis and the Arkansases — you are going to have very, very limited eligibility,” Caplan said. “So it really risks harming very vulnerable people.”
Oz lost the 2022 Senate race to Democrat John Fetterman, who at the time questioned his commitment to protecting safety net programs like Medicare, even claiming he’d “destroy” it.
Now, he says he’s “open to having a dialogue” with Oz.
“We’re going to have to hear what his answers are, and then we’re going to go from there,” Fetterman said in an interview. “His positions are going to be what Trump’s position is.”
“He’s going to pick people that are going to disagree with me, and they’re never going to be my first choice. So that’s kind of how democracy tends to work,” Fetterman said. “It’s not even Thanksgiving right now, and I’m not going to be part of the collective freakouts.”
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