If confirmed to run the Centers for Medicare & Medicaid Services, television personality Dr. Mehmet Oz, President-elect Donald Trump’s nominee, would oversee two large federal health insurance programs that cover about 2 in 5 Americans and greatly influence the nation’s health care system.
Beyond providing direct health insurance coverage to older adults and low-income families, CMS also oversees the Affordable Care Act and federal payments to hospitals and doctors.
CMS runs Medicare, the federal health program for U.S. residents 65 and older and some younger people with a qualifying medical condition. Nearly 68 million people are covered by traditional government-run Medicare or Medicare Advantage plans offered by private health insurance companies but subject to CMS oversight.
CMS also oversees Medicaid, the federal health program for low-income families that covers 72 million people. Another 7 million children were enrolled in the Children’s Health Insurance Program as of July.
The federal agency also oversees the Affordable Care Act health insurance for millions of Americans. As such, the agency regulates ACA plans sold over Healthcare.gov or state-based insurance exchanges.
In all, CMS employs over 6,000 staffers and operates a half dozen centers in charge of everything from clinical quality standards to innovation. CMS is under the umbrella of the U.S. Department of Health and Human Services, which also oversees the Centers for Disease Control and Prevention and the Food and Drug Administration. Trump has nominated Robert F. Kennedy Jr. to lead HHS.
Because it oversees payments to doctors and hospitals who take Medicare and Medicaid, the agency’s fee schedules often set the template that private health insurance plans use to negotiate reimbursement rates with health providers.
Under President Joe Biden’s 2022 climate and health legislation known as the Inflation Reduction Act, Medicare was empowered to negotiate prices with pharmaceutical companies on a limited number of medications.
Earlier this year, Medicare announced negotiated discounts with pharmaceutical companies on 10 drugs prescribed to treat blood clots, cancer, heart disease and diabetes. The price discounts won’t take effect until 2026. Another 30 drugs will be selected over the next two years for negotiated prices that will be rolled out in 2027 and 2028.
Nearly all U.S. hospitals accept Medicare, and as part of such participation, are subject to on-site inspections, called surveys. These surveys verify that hospitals meet standards set by the agency.
If confirmed by the Senate, Oz would succeed Chiquita Brooks-LaSure, who held a high-ranking position within CMS when the Affordable Care Act was launched under President Barack Obama. She worked in the private sector during Trump’s first term and returned to serve as CMS administrator during the Biden administration.
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