Consider This from NPR: What DOGE Could Mean for Medicare and Medicaid?

Release Date: February 10, 2025
Host: Ari Shapiro
Guests:

• Kathleen Sebelius: Former Health and Human Services Secretary under President Obama
• Mark McClellan: Former Medicare and Medicaid Services Administrator under President George W. Bush

Introduction

In this episode of NPR's Consider This, host Ari Shapiro delves into the expanding influence of Elon Musk's newly formed Department of Government Efficiency (DOGE) within the federal government, particularly its recent foray into the Centers for Medicare and Medicaid Services (CMS). The discussion centers on the potential ramifications of DOGE's involvement in these critical healthcare programs, exploring both opportunities for reducing fraud and concerns about broader policy shifts.

Understanding Medicare and Medicaid

Ari Shapiro begins by outlining the scope of Medicare and Medicaid, underscoring their significance in the U.S. healthcare system:

• Medicare insures approximately 66 million Americans aged 65 and older.
• Medicaid provides coverage to about 80 million low-income individuals and those with disabilities.

Kathleen Sebelius emphasizes the financial magnitude of these programs, noting that they account for a substantial portion of federal and state budgets due to the higher healthcare needs of their beneficiaries. Mark McClellan adds that Medicare incurs higher per-person costs driven by the age-related health issues of its enrollees, while Medicaid remains a cost-efficient program, especially for women and children, covering nearly half of all births in the United States.

Elon Musk’s DOGE and Its CMS Engagement

The episode shifts focus to Elon Musk's DOGE, which has recently accessed CMS systems with the purported aim of combating fraud. Sebastian highlights Musk's assertion that “big money fraud is happening” [00:00], a statement that has raised eyebrows and sparked debate among healthcare experts.

Kathleen Sebelius states, “The staff at CMS are in place now... there’s a whole team of people who are in politically appointed deputy roles working with the career staff who have a lot of experience with CMS and the private sector” [05:03]. She underscores the existing expertise within CMS, suggesting that DOGE's integration could leverage this experience to enhance fraud detection and system modernization.

Expert Insights on DOGE’s Potential Impact

Mark McClellan offers a cautious perspective on DOGE's involvement. He acknowledges the ongoing battle against fraud, waste, and abuse, highlighting the efforts made during the Obama administration to intensify these initiatives [04:15]. However, he expresses skepticism about DOGE’s proposals, warning that Republican-led efforts may prioritize cutting benefits over genuine fraud reduction. McClellan warns, “You really have to go to the core of the benefits of these programs. And that is where I'm very wary of what the proposals are coming forward” [06:55].

The conversation also touches on the stability of CMS under DOGE's oversight. Kathleen Sebelius points out that, unlike other government departments where career officials have been replaced or sidelined, CMS retains its experienced, nonpartisan staff committed to maintaining program integrity [06:07].

Potential Implications and Concerns

A significant concern discussed is whether DOGE's mission to eliminate fraud could be a façade for broader, sweeping changes to Medicare and Medicaid unrelated to fraud. Sebelius emphasizes trust in the CMS team's capabilities: “The CMS team has also brought in some long experienced career professionals... working with Medicare and Medicaid programs” [05:03]. This suggests a commitment to data-driven approaches rather than partisan restructuring.

Mark McClellan cautions listeners about the uncertain future of their coverage, advising that any significant changes could have widespread effects on state budgets and essential services. He warns, “If Congress begins to change Medicaid rules, payments about Medicaid programs, it will blow up every state budget in this country” [07:52]. This highlights the interconnectedness of Medicaid with various state-funded initiatives, including education and economic development.

Advice for Beneficiaries

For individuals relying on Medicare and Medicaid, Sebelius and McClellan provide guidance amidst the potential changes:

• Continuity of Coverage: "Assume the services that you signed up for... the services your provider, your drugs, will continue to be provided and use them" [07:40].

• State-Level Vigilance: Advocating for state legislators to remain proactive, McClellan underscores the importance of states maintaining their Medicaid partnerships with the federal government to protect against abrupt policy shifts [07:52].

Conclusion

The episode wraps up with a balanced view from both guests, acknowledging the importance of addressing fraud and inefficiencies within Medicare and Medicaid while remaining vigilant against potential political motivations that could undermine these vital programs. Sebelius and McClellan both commend the CMS team's dedication and expertise, offering a cautious optimism that DOGE's involvement could lead to meaningful improvements without compromising the integrity or accessibility of healthcare services for millions of Americans.

Produced by: Mia Venkat and Alaina Burnett
Edited by: Courtney Dorning and Nadia Lancy
Executive Producer: Sami Yenigun

Notable Quotes

• Elon Musk on Fraud: “Big money fraud is happening.” [00:00]

• Mark McClellan on Program Efficiency: “Medicaid is actually one of the most, if you will, by cost-efficient programs for women and children.” [03:09]

• Kathleen Sebelius on CMS Expertise: “The CMS team has also brought in some long experienced career professionals...” [05:03]

• Mark McClellan on Potential Policy Shifts: “You really have to go to the core of the benefits of these programs. And that is where I'm very wary of what the proposals are coming forward.” [06:55]

• Advice to Beneficiaries: “Assume the services that you signed up for... the services your provider, your drugs, will continue to be provided and use them.” [07:40]

For more insightful analyses and discussions on major news stories, tune into Consider This by NPR.