What DOGE could mean for Medicare and Medicaid?

Summary

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

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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.

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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.

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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.

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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].

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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.

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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].

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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.

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

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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]

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

Transcript

[Ari Shapiro]

Elon Musk's Department of Government Efficiency is quickly expanding its reach through the federal government. It recently accessed systems at the Centers for Medicare and Medicaid Services. Musk and his team are now looking at key payment and contracting systems for Medicare and Medicaid. That was first reported by the Wall Street Journal on X. Musk said he believes, quote, big money fraud is happening. In this episode, we'll get to the impact of DOGE operating at cms. But first, a quick reminder of what these programs actually Medicare insures older people. Medicaid offers insurance to low income people and those with disabilities. Consider this these two health insurance programs serve tens of millions of people and they consume a huge part of federal and state budgets. So how could DOGE impact these services? From npr, I'm Ari Shapiro.

[Jen Chavez]

Evergreen trees are Pacific Northwest icons in journalism. An evergreen story isn't tied to one news cycle. It goes deep and helps you understand the world. The Evergreen is also a podcast from OPB about the Northwest. I'm Jen Chavez. Listen to the Evergreen Podcast from OPB every Monday, part of the NPR Network. Donald Trump is starting his second term as president. What will his administration do and what policies will it promote? On the NPR Politics podcast, we'll break down what the new administration does and expect, explain why it matters. Listen to the NPR Politics podcast every day. Hey, it's Rachel Martin from Wildcard. This Valentine's Day, NPR wants to show our love for listeners like you by giving away a free year of NPR plus and a hundred dollars worth of NPR merch to one lucky winner. Enter for a chance to [e-mail] Valentine no purchase necessary Entry page and a link to the official rules can be.

[Ari Shapiro]

[e-mail] Valentine it's consider this from NPR. Medicare provides health care to 66 million people who are 65 and older. Medicaid serves 80 million low income people and disabled Americans. To understand how Elon Musk's Department of Government Efficiency might impact those services, we've invited two former senior government officials to join us. Kathleen Sebelius was Health and Human Services secretary under President obama. And Mark McClellan was Medicare and Medicaid Services administrator under President George W. Bus. Good to have you both here.

[Kathleen Sebelius]

Great to be with you, Ari.

[Mark McClellan]

Good to be with you.

[Ari Shapiro]

How big a part of the overall US Healthcare system are these programs?

[Kathleen Sebelius]

Well, it's less than half of the population, but roughly half and maybe a little bit more of expenditures because the people in these programs have some of the more serious healthcare needs. Higher rates of chronic diseases that go along with being from low income and maybe historically underserved backgrounds, higher rates of chronic diseases that go along with with aging and the risk factors for many conditions like cancer and other health problems that go up with age.

[Mark McClellan]

And Ari, I think it's important that maybe listeners understand that Medicare has a much higher cost per person because of the age of the population. Medicaid is actually one of the most, if you will, by cost efficient programs for women and children. About half of the births in the United States are paid for by Medicaid.

[Ari Shapiro]

So, Kathleen, when you saw Elon Musk post on X that Medicare and Medicaid were where the big money, in his words, fraud is happening, did that ring true to you? Was that a big concern of yours when you ran hhs?

[Mark McClellan]

Fraud, waste and abuse have always been a focus of the federal agencies. One of the things that happened with the Obama administration was really ramping up the kind of fraud, rooting out activities that we did in court with the Department of Justice. The notion that this is somehow an undiscovered area, that people who are not at all familiar with the programs or the way they operate are going to suddenly be able to identify and root out is just flat out wrong.

[Ari Shapiro]

Mark, how did you react to seeing that post from Elon Musk?

[Kathleen Sebelius]

Well, I totally agree with Kathleen that this is an ongoing battle. So I think that the real question for Doge is can they find a way to get these inappropriate programs out while by the are at the same time keeping President Trump's promise that he is not going to cut or disrupt Medicare benefits?

[Ari Shapiro]

Do you fear that this mission to eliminate waste and fraud could be a pretext for making broader, sweeping changes to Medicare and Medicaid that are not actually motivated by waste and fraud and don't actually address waste and fraud.

[Kathleen Sebelius]

The reason that I'd like to take them at their word, Ari, is that the staff at cms, cms, the center.

[Ari Shapiro]

For Medicare and Medicaid Services, Centers for.

[Kathleen Sebelius]

Medicare and Medicaid Services that oversees these programs. They are in place now. So Dr. Mehmet Oz, Dr. Oz has been nominated to be the next administrator. He's still waiting for a confirmation hearing, so he's not there. But in contrast to some of the other public health agencies at hhs, 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 working with Medicare and Medicaid programs. The CMS team has also brought in some long experienced career professionals, including People who were there on the career staff working with me, including the new chief operating officer at CMS, who has a tremendous amount of nonpartisan experience in finding ways to address fraud, waste and abuse in Medicare and Medicaid programs.

[Ari Shapiro]

So just so I understand, in other parts of the government, from the Treasury Department to the Justice Department, we have seen career officials and nonpartisan civil servants either fired and replaced or encouraged to leave. You're saying the opposite appears to be true at the Centers for Medicare and Medicaid Services?

[Kathleen Sebelius]

I think something distinct is happening here and that, you know, the DOGE team, as I understand it, didn't just show up, but is working directly following some of the guidance and the experience of the career staff and the political leadership to find the effective ways of addressing fraud and abuse and hopefully to modernize some of the data systems there too.

[Ari Shapiro]

Kathleen, do you give them the benefit of the doubt? Do you trust them to take a nuanced, data driven approach?

[Mark McClellan]

Well, I'm encouraged by what Mark is saying about what his knowledge is about people who are coming into the agency. But the proposals, Ari, that are out by, I would say Republicans in Congress are very much aimed, particularly in the Medicaid program, at cutting benefits. They are not about fraud, waste and abuse. You can't really, I would suggest, get the kind of money that has been promised by Doge, even if you greatly ramp up fraud, waste and abuse, 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.

[Ari Shapiro]

So bottom line, if people who depend on these programs want to know, is my coverage safe? Can I continue to count on the services that I have counted on in the past? We don't know where this is going to go. What should people be watching?

[Mark McClellan]

Well, I would say for now, until they are notified otherwise, assume the services that you signed up for. If you've just gone through Medicare open enrollment or if you are a member of your state's Medicaid program, the services your provider, your drugs, will continue to be provided and use them. I think it's very important at the state level, particularly that legislators in red and blue states understand that if Congress begins to change Medicaid rules, payments about Medicaid programs, it will blow up every state budget in this country. Medicaid is one of the most important parts of every state's budget. They rely heavily on a shared partnership with the federal government. And if those rules begin to change, everything else is at risk. Economic development, the ability to fund education, the tax system, and states will be left in the really unfortunate position of having to pick and choose who gets to keep their coverage and who doesn't.

[Ari Shapiro]

That is former Health and Human Services Secretary Kathleen Sebelius, a Democrat, and former Medicare and Medicaid Services Administrator Mark McClellan, a Republican. Thank you both for joining us today.

[Mark McClellan]

Thanks for having us.

[Kathleen Sebelius]

Thanks, Ari.

[Ari Shapiro]

This episode was produced by Mia Venkat and Alaina Burnett. It was edited by Courtney Dorning and Nadia Lancy. Our executive producer is Sami Yenigun. It's Consider this from npr. I'm Ari Shapiro.

[Mark McClellan]

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[Kathleen Sebelius]

Want to hear this podcast without sponsor breaks? Amazon prime members can listen to Consider this sponsor free through Amazon Music. Or you can also support NPR's vital journalism and get consider this [e-mail] that's plus.NPR.org.