MW Trump's push to privatize Medicare would be a disaster for taxpayers - especially seniors

By Andrea Ducas and David Lipschutz

Medicare Advantage is more costly for Americans than traditional Medicare. So why does Trump favor it?

The Trump administration could try to steer every Medicare recipient into private coverage via the Medicare Advantage program - whether they want it or not.

Congress is geared for an explosive public fight over catastrophic Medicaid cuts, but an ominously quieter shift is underway for the Medicare program: full-scale privatization.

According to recent reporting, it appears the Centers for Medicare & Medicaid Services $(CMS)$ Innovation Center has been ordered to draw up plans for implementing the far-right Project 2025 goal of making Medicare Advantage $(MA)$ - otherwise known as privatized Medicare -the default for all Medicare enrollees.

In other words, the Trump administration could try to steer every Medicare recipient into private coverage via the Medicare Advantage (MA) program - whether they want it or not.

Such a move would be consistent with Trump's vigorous support for the MA program over the years. His pick to lead CMS, Dr. Mehmet Oz, spent his career pushing for fully privatized Medicare through a plan he actually called "Medicare Advantage for all."

Right out of the gate, Trump's first set of decisions for the Medicare program were to substantially increase payments to private MA plans and to walk back a set of policies - like prior authorization guardrails and informed decision-making requirements for brokers - the Biden administration planned to implement to protect enrollees from industry abuses.

During his first presidential term, Trump aggressively promoted private MA plans, relaxed restrictions on MA plan marketing, and allowed MA plans to offer questionable non-health-related benefits like pest control and air-quality equipment that likely serve as little other than marketing tools. His actions were so biased in favor of MA that in 2018, the CMS Open Enrollment web page didn't even list traditional Medicare as an enrollment option for beneficiaries. Unsurprisingly, by the time he left office, MA enrollment had grown by 31%.

This time around, by reportedly pushing to make privatized Medicare the default for all enrollees, Trump appears to want to go much further. And he might succeed.

Here's why: The Medicare statute is clear that when a person first enrolls they must be defaulted into traditional Medicare unless they specifically choose to opt for MA. Yet the CMS Innovation Center has the power to waive virtually any statutory provision in order to "test innovative payment and service-delivery models to reduce program expenditures." Though not the intent of the statute, this sweeping authority could conceivably extend to forcing beneficiaries into plans they had no say in choosing for themselves.

Trump and Oz are also reportedly attempting to push default privatization in another less-obvious way, by reviving a CMS Innovation Center program from the first Trump administration that experts have cautioned would forcibly enroll Medicare beneficiaries in "managed care-like" (read: private) plans. In regions chosen to pilot the program, basically anyone on Medicare, including people dually eligible for Medicare and Medicaid, would be required to enroll in those plans.

Adopting either approach would undermine the choice every Medicare enrollee has had the right to make since the beginning of the program, and could push enrollees into plans rife with burdensome prior authorization requirements and limited networks. In contrast to traditional Medicare, which offers access to nearly any provider in the country with minimal interference, virtually everyone in MA has to get approval for at least some services, and there is no evidence MA enrollees get higher quality care as a result. In fact, by some measures - like being able to get care from top-ranked cancer hospitals - MA enrollees fare worse.

Make no mistake: This would also be a disaster for taxpayers. This year, the government is projected to spend at least $84 billion more on MA enrollees than it would have spent if those same beneficiaries were instead covered by traditional Medicare. According to a recent report from the Center for American Progress, if default MA enrollment were to increase the number of Medicare beneficiaries enrolled in MA from the current 51% to just 75%, MA overpayments would cost us $2 trillion over the next decade. Corporations would profit enormously at the expense of American seniors.

Trump's reported push for fully privatized Medicare - poised for a swift assist from newly-confirmed CMS Administrator Oz - should alarm everyone. It's now incumbent upon our congressional leaders to act decisively and ensure the traditional Medicare program isn't whittled out of existence. It's imperative that Congress protect beneficiary choice by passing legislation that expressly prohibits any form of default enrollment into Medicare Advantage. Medicare's future depends on it.

Andrea Ducas is the vice president of health policy at the Center for American Progress. David Lipschutz is the codirector of law and policy at the Center for Medicare Advocacy.

More: When it comes to Social Security and Medicare, this is what the nation's top experts on aging worry about

Also read: Here's what Trump needs to do if he really wants to stop Big Pharma from ripping seniors off

-Andrea Ducas -David Lipschutz

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May 06, 2025 07:35 ET (11:35 GMT)

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