PNHP

Stand-Up for Simple Health Insurance

Stand-Up for Simple Health Insurance

In just 90 seconds, this highly entertaining comic conveys the absurd complexity of health insurance out-of-pocket costs. It’s a potent tragi-comic case for affordable, simple health insurance. Finally, the difference between HSAs and FSAs is clear!

“Oh my God, like what is going on with the healthcare system?” or on YouTube, 1.5 minute video, April 15, 2025, by Darlene Bereznicki

Comment:

By Jim Kahn, M.D., M.P.H.

Ms. Bereznicki starts her riff with “When the Luigi Mangione thing went down, my Canadian friends asked … OMG what is going on with the healthcare system?” That’s the question we’re all asking ourselves, all the time. Leave it to a professional comedian to answer to that question so well and amusingly, in just a minute and a half. Maybe she should delivery my health policy talks!

Deductibles, copays, out of pocket maximums, etc – she quickly covers the gamut. This routine even alerted me to the fundamental difference between HSAs (health savings accounts, which roll over tax-free to retirement*) and FSAs (flexible spending accounts, use them or lose them).

Note the massive attention to the Instagram video in just five days, and all the supportive comments. (The YouTube video was just uploaded by Ms. Bereznicki, as a favor to HJM readers.)

Why did this resonate so widely? Because we’re all fed up with a laughably convoluted and inefficient – plus unfair and harmful – set of clunky mechanisms to pay for health care. Ms. Bereznicki and her Canadian friends would agree I’m sure: the US needs a single public payer, with minimal or no cost sharing.

* HSAs are a major gift to the healthy and wealthy, and undercut insurance markets…

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Dr. Diljeet Singh on More Perfect Union

PNHP president Dr. Diljeet Singh spoke to More Perfect Union for a video segment that was posted on April 15, 2025.

She talked about the blatant conflicts of interest that should have been a red flag for senators voting on the nomination of Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services—especially his enthusiasm for the so-called “Medicare Advantage” program, and his investments in firms like UnitedHealthcare.

“Every single health care dollar should go to health care,” said Dr. Singh, “not profit and not shareholder dividends.”

MA Insurers Reap $60 Billion from Premium Boost & Inflated Diagnoses

The 2026 CMS premium increase and a new study together highlight how Medicare Advantage plans fleece tens of billions from the government. Trump’s CMS raised premiums by $25 billion from Biden-era plans, and diagnostic up-coding generates $33 billion in excess payments annually.

Summary: The 2026 CMS premium increase and a new study together highlight how Medicare Advantage plans fleece tens of billions from the government. Trump’s CMS raised premiums by $25 billion from Biden-era plans, and diagnostic up-coding generates $33 billion in excess payments annually. Read this online here.

Trump’s CMS dramatically raises payments to Medicare Advantage plans, Healthcare Dive, April 8, 2025, by Rebecca Pifer

The Trump administration handed Medicare Advantage plans a massive gift on Monday, finalizing payment rates for 2026 significantly higher than what regulators in the Biden administration sketched out.

The 5.1% benchmark increase should accelerate margin recovery for the privatized Medicare plans … Insurer stocks soared [up to 16%] after the payment notice was announced.

The 5.1% rate increase for MA plans is the largest rate increase in the past decade, and is up significantly from the 2.2% increase proposed by the Biden administration in January.

Overall, it should result in more than $25 billion in additional payments going to MA plans next year, according to the CMS.

However, the real sum will be higher, given the CMS’ estimate doesn’t include the impact of plans’ coding practices. The expected change in revenue for MA plans jumps from 5.1% to 7.2% including the impact of risk scoring.

“This reads very positive” for insurers, Mayo said.

“Overall, we view the [2026] Final notice as a best-case scenario,” Ryan Langston, analyst with TD Cowen, wrote in a Monday note.

Insurer-Level Estimates of Revenue from Differential Coding in Medicare Advantage, Annals of Internal Medicine, April 2025, by Richard Kronick et al.

Background: Medicare Advantage (MA) plans report diagnoses more intensely than providers in traditional Medicare (TM), and there is wide variation in coding intensity across MA plans.

Participants: 697 MA contracts offered by 193 insurers.

Results: In 2021, the average risk score was 1.26 in MA vs 1.07 in TM. … The risk score at UnitedHealth Group was 0.28 higher than it would have been if its plans had coded identically to TM. … Kaiser Permanente coded only slightly more intensely than TM. Due to differential coding, MA plans received an estimated $33 billion in additional payment in 2021, 42% of which went to UnitedHealth.

Comment:

By Jim Kahn, M.D., M.P.H. and Don McCanne, M.D.

We linked these two stories because they reveal a common theme: regulatory capture to add profits and shareholder value for the private insurers that operate Medicare Advantage. The big premium hike reflects MA lobbying power, especially in a GOP administration; the diagnostic upcoding suggests confidence that CMS will never clamp down on this misbehavior (recent efforts were beaten back, see here and here),

The overpayments are huge. The $60 B total annual cost of generous premium-setting plus over-diagnosis is 6-30 times higher than all DOGE cuts, according to estimates of true DOGE efficiencies from the American Enterprise Institute ($10 billion) and the Financial Times ($2 billion). Thus, while the Trump administration pretends to find efficiencies, it overpays insurers many times more. They don’t really care about efficiency, they care about enriching wealthy companies and individuals. (Of course, looming Medicaid cuts may reach $90 billion per year … but that’s not an “efficiency” instead a reduction in medical access and care.)

What is alarming for the future is that the Trump administration appears to be injecting new life into Medicare Advantage private insurers as a prelude to fully displacing traditional Medicare. Privatizing Medicare would have the adverse consequences of handing even more tax funds to private insurers, while increasing care costs for patients. We would lose choice of providers, forced into narrow networks and declining access to specialized services for complex medical conditions, as is frequent in MA. The model favored by current CMS leadership (Mehmet Oz) will encourage private insurers to tailor their plans for a competitive marketplace by adding benefits of limited value such as current dental, vision, and hearing care – thus appearing to offer generous benefits when, in fact, they shift costs to patients via stricter prior authorization requirements and increased claim denials. They’ll also shorten the list of medical benefits, claiming that many legitimate treatments are still experimental and lack sufficient scientific support to be covered.

Geek Notes: In the graph, appreciate the strikingly high jump from “advance” (under Biden) to “final” (under Trump) for 2026. Kronick’s estimate of $33 B due to diagnostic coding intensity is up from the $20 B previously discussed in HJM, despite being for 2021, several years out of date. In theory CMS is revising diagnostic coding practices, to reduce the overage, but such efforts have been dismally unsuccessful in the past.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Physicians condemn irresponsible and dangerous rate hike for “Medicare Advantage” corporations

“This misuse of taxpayer dollars is all the more egregious in the face of how much harm these insurance corporations inflict on millions of seniors”

FOR IMMEDIATE RELEASE: April 9, 2025

Media Contact: Anika Thota, PNHP Policy & Communications Specialist, anika@pnhp.org

On April 7, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized a 5.06% increase in payments to Medicare Advantage (MA) plans for 2026—more than double the 2.23% increase originally proposed in February based on CMS’s own actuarial projections.

Physicians for a National Health Program (PNHP) strongly condemns the hike, which is the direct result of aggressive lobbying from health insurance corporations that demanded and secured billions of Medicare dollars at the expense of the American public.

“For the first time in our nation’s history, Congress has hired a licensed insurance broker to be in charge of Medicare,” said Dr. Ed Weisbart, PNHP’s national board secretary. “It should come as no surprise, then, that within less than one week of his being confirmed by the Senate, he authorized the single largest increase in payments to Medicare Advantage for more than a decade.”

Corporate MA insurers already receive an estimated $140 billion in annual overpayments, driven by upcoding, favorable selection, and manipulation of bonus payments—with patients and doctors ultimately paying the price.

Medical practitioners now spend an estimated 11 to 20 million hours every year navigating prior authorization requests from MA plans. These administrative barriers directly contribute to delayed care, with MA enrollees nearly twice as likely to report care delays compared to those in traditional Medicare. At the same time, over 11 million beneficiaries are trapped in narrow networks that exclude most physicians in their area. And despite promises of “affordability,” at least 7.3 million enrollees are underinsured, facing high out-of-pocket costs for needed care.

“This misuse of taxpayer dollars is all the more egregious in the face of how much harm these insurance corporations inflict on millions of seniors, people with disabilities, rural hospitals, and physicians and other clinicians across the United States,” said Dr. Weisbart.

Against this backdrop of widespread denial, restriction, and profiteering, CMS’s decision to raise payments even further is not just irresponsible—it’s dangerous. The 5.06% rate hike rewards an already failing and exploitative system, pouring billions more into plans that consistently underdeliver on access, equity, and care.

Physician leaders from PNHP are available for interviews to speak on the implications of this decision and the urgent need to end Medicare Advantage overpayments. Please contact PNHP Policy and Communications Specialist, Anika Thota at anika@pnhp.org for interview requests.

Physicians for a National Health Program (pnhp.org) is a nonprofit research and education organization whose more than 25,000 members support single-payer Medicare for All reform.

Poll Shows Rising Health Cost Insecurity

New national polling finds a drop in adults’ ability to access and pay for quality health care. Worst off are low earners and racial/ethnic minorities. Half of US adults – more than 125 million people – are “cost desperate” or “cost insecure” regarding health care.

In U.S., Inability to Pay for Care, Medicine Hits New High, Gallup, April 2, 2025, by Dan Winters and Ellyn Masse

The percentage of U.S. adults who have recently been unable to afford or access quality healthcare has reached 11% — equivalent to nearly 29 million people — its highest level since 2021, according to new findings from the West Health-Gallup Healthcare Indices Study, which classifies these individuals as “Cost Desperate.”

The most notable increases since 2021 have occurred among Hispanic adults (up eight percentage points to 18%), Black adults (up five points to 14%,) and the lowest-income households, earning under $24,000 per year (up 11 points to 25%). Meanwhile, there has been no meaningful change in the proportion of White adults or middle- to high-income earners facing the same level of struggle. As a result, disparities in access to healthcare based on race, ethnicity and income are also at their highest point since surveying began.

“Cost Desperate” individuals lack access to quality, affordable care and have recently been unable to pay for needed care and medicine.

“Cost Insecure” individuals lack access to quality, affordable care or have recently been unable to pay for either needed care or medicine.

“Cost Secure” individuals have access to quality, affordable care and can pay for needed care and medicine.

The percentage of adults [who are “Cost Secure”] has reached its lowest level, with only about half of Americans (51%) falling into this category. The demographic groups who saw the biggest drops are Hispanic adults (down 17 points to 34%) and Black adults (down 13 points to 41%).

While households earning under $48,000 annually have always reported more difficulty accessing affordable healthcare, the difficulty has worsened considerably in the past year, climbing by 11 points (to 64%) among those in households earning under $24,000 and 12 points (to 57%) among those in households earning $24,000 to less than $48,000.

Implications:

The erosion of cost security in healthcare comes with serious practical implications for the American public. Recent research from West Health and Gallup shows that 12% of U.S. adults report borrowing money to pay for healthcare last year, amounting to an estimated $74 billion borrowed, and nearly 60% of U.S. adults report feeling “somewhat” or “very” concerned about going into debt due to a major medical event. Other common effects of care unaffordability include significant stress for household members, having to cut spending on basic items such as food, transportation and utilities to pay for care, and staying in an unwanted job solely for the health benefits.

Comment:

By Don McCanne, M.D.

In spite of the fact that the United States spends more than any other nation on health care, our financing system leaves more people exposed to unaffordable costs, and this study shows that it is getting worse.

What is the outlook? The current administration wants to reduce government spending in order to provide large tax cuts for the wealthy. Medicare is likely to be further privatized, shifting more profits and administrative expenses to the private insurers which would be paid through increased premiums, cost sharing, and taxes. Many states are electing to reduce spending on the Medicaid program, leaving patients responsible for more of the costs. The Republicans have made repeated efforts to reduce government spending on the Affordable Care Act and are likely to continue in their efforts. These measures would further reduce the affordability of health care for those enrolled in these programs.

This is so unnecessary. We have a plethora of studies that show that we can provide affordable health care to everyone and pay for the increases in care with the efficiencies inherent in a well-designed single payer system – an improved Medicare for All.

We’ve been saying this for years. Isn’t it about time that we actually do it?

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Trump’s CMS dramatically raises payments to Medicare Advantage plans

The CMS said the hike reflects more recent data on cost growth, though one analyst said the Trump administration “had its finger on the scale.”

By Rebecca Pifer
Healthcare Dive, April 8, 2025

Dive Brief:

  • The Trump administration handed Medicare Advantage plans a massive gift on Monday, finalizing payment rates for 2026 significantly higher than what regulators in the Biden administration sketched out.
  • The 5.1% benchmark increase should accelerate margin recovery for the privatized Medicare plans following years of rates they said were insufficient — especially as those rates coincided with rising costs for seniors’ care. Insurer stocks soared after the payment notice was announced.
  • The Trump administration also completed phasing in changes to insurers’ coding practices meant to make it harder to for them to inflate members’ sicknesses to garner higher reimbursement. The changes are unpopular with MA plans, which lobbied heavily to reverse them.

Dive Insight:

The 5.1% rate increase for MA plans is the largest rate increase in the past decade, and is up significantly from the 2.2% increase proposed by the Biden administration in January.

Overall, it should result in more than $25 billion in additional payments going to MA plans next year, according to the CMS.

However, the real sum will be higher, given the CMS’ estimate doesn’t include the impact of plans’ coding practices. The expected change in revenue for MA plans jumps from 5.1% to 7.2% including the impact of risk scoring.

It’s difficult to say how much this will inflate reimbursement in MA next year, a program that’s expected to cost taxpayers almost $600 billion overall in 2025.

But “CMS’ estimate of risk score trend would certainly increase the payments going to MA plans next year even beyond the estimate given in the rate notice,” said Lynn Nonnemaker, a senior director with healthcare consultancy McDermott+.

Final rates are generally higher than proposed ones, but the jump between the two was larger than some analysts had expected.

The CMS said the final rate is more generous because it was calculated using more recent data that reflects even higher spending in Medicare, as reimbursement attempts to catch up to the cost growth that’s hit payer’s profits over the past year.

Regulators increased the effective growth rate, a metric that tracks cost growth in Medicare, by more than 3 percentage points to upwards of 9% in the final notice. That “may be the largest increase we have seen,” Whit Mayo, an analyst with Leerink Partners, wrote in a Monday note.

“This reads very positive” for insurers, Mayo said.

It’s not surprising that the growth rate increased substantially, given the inclusion of data from the third and fourth quarters and plans’ prior concerns that previous estimates were too low, Nonnemaker noted. But “I can’t say that I expected 9%,” she said.

The rate notice reinforces that “MA rates are influenceable,” given the CMS gave “generous upward revisions” to multiple metrics that factor into cost growth, wrote Jefferies analyst David Windley in a Monday note.

“We maintain the Trump admin had its finger on the scale,” he said.

Trump’s CMS, under newly confirmed Administrator Dr. Mehmet Oz, the physician and television personality, was expected to be friendlier to MA plans as Oz has expressed support for the privatized Medicare program in the past.

However, during his confirmation process Oz walked a fine line between supporting MA and pledging to curb profiteering in the plans that’s brought them under congressional scrutiny and sparked discontent among the American public.

Early MA rules from Trump administration suggest regulators are committed to balancing on that tightrope. The CMS also recently finalized a rule putting some guardrails around MA plans’ coverage denials, but declined to take more radical steps proposed by its predecessors.

Regulators in the Biden administration were worried that the Trump administration would halt changes to how MA plans adjust for beneficiary risk, calling the reform “crucial” to ensure payment accuracy in a fact sheet on their proposed rule in January.

The adjustments are meant to prevent upcoding, when insurers exaggerate their members’ health needs to get higher reimbursement from the government. They do so by making plans’ coding processes more accurate, including removing frequently gamed medical codes from the risk adjustment model.

The CMS first instituted the changes in 2023, but have rolled them out over three years to lessen the shock on insurers. In 2026, 100% of beneficiary risk scores are set to be calculated using the new model.

That remains the plan. Finalizing the model will “improve payment accuracy and reduce burden,” the CMS wrote in the final rule, adding that MA plans have had ample time to assess the impact of its implementation.

“Given this experience, we do not think it is necessary to further delay,” the CMS said.

The Trump administration also finalized other payment policies that could cut into MA plans’ earnings, including changes to how normalization factors, which adjust risk scores for enrollees, are calculated for prescription drug plans — a proposal the CMS received considerable pushback on in comments on the rate, according to Nonnemaker.

Still, the Better Medicare Alliance, a lobby for the MA industry, thanked the Trump administration for “fully funding” MA in a statement Monday.

Stocks in major MA payers, including UnitedHealth and Humana, jumped aftermarket Monday following the rule’s release. Humana, which is particularly exposed to MA, quickly climbed 16% after the rates were announced.

The payment hike should help insulate insurers from the worst of rising costs, which flattened margins last year as seniors in the privatized Medicare plans used more medical care than expected. National payers have already cut benefits and exited underperforming markets for 2025 in a bid to resuscitate margins.

Plans will likely funnel the higher reimbursement in 2026 into improving profits, but could also increase their benefits, analysts said. That could result in even more Medicare-eligible seniors electing to join MA.

“Overall, we view the [2026] Final notice as a best-case scenario,” Ryan Langston, analyst with TD Cowen, wrote in a Monday note.

https://healthcaredive.com…

The Impact of Health Insurance on Mortality

By Helen Levy, Ph.D. and Thomas C. Buchmueller, Ph.D.
Annual Review of Public Health, April 2025

Abstract

A 2008 review in the  considered the question of whether health insurance improves health. The answer was a cautious yes because few studies provided convincing causal evidence. We revisit this question by focusing on a single outcome: mortality. Because of multiple high-quality studies published since 2008, which exploit new sources of quasi-experimental variation as well as new empirical approaches to evaluating older data, our answer is more definitive. Studies using different data sources and research designs provide credible evidence that health insurance coverage reduces mortality. The effects, which tend to be strongest for adults in middle age or older and for children, are generally evident shortly after coverage gains and grow over time. The evidence now unequivocally supports the conclusion that health insurance improves health.

full review:
https://www.annualreviews.org…

DOGE to Merge Federal Healthcare Funding Programs

In pursuit of budget savings, Elon Musk’s Department of Government Efficiency has decided to combine disparate government health care financing programs into one streamlined operation using a standardized provider payment model. DOGE claims $250 billion in annual savings from this “unified financing.”

DOGE Consolidating Healthcare Benefits, Intrepid News, April 1, 2025, by Dorough E. Sizdah

The Department of Government Efficiency (DOGE), headed by Elon Musk, appears poised to consolidate all federal mechanisms that pay for healthcare. The new agency, “Caring for America,” will absorb funding and personnel from dozens of existing departments and programs. Overall spending will be reduced by a claimed $250 billion per year, via procedural streamlining and elimination of contracting overhead.

The programs to be combined include Medicaid and Medicare (currently part of CMS), the Veteran’s Health Administration, the Children’s Health Insurance Program (CHIP), Affordable Care Act exchanges, PACE (for seniors), the Ryan White Care Act (HIV care), the Indian Health Service, Federal Employees Health Benefits Program (FEHBP), Federally Qualified Health Centers, and dedicated immunization efforts, among others. Benefits will be standardized at the highest existing level.

DOGE employees and senior policy staff from the affected agencies envision this shift as start of a “Unified Financing” approach to health care. All medical providers would be paid directly for services, without use of intermediaries, and based on prices set in collective bargaining with representatives of the provider groups. Mr. Musk developed procedures for payment efficiency based on his design of PayPal, a popular electronic payment software which was his first major business success.

One confidential source characterized this consolidation of federal health program bureaucracy and payment mechanisms as a first step to broader health insurance streamlining. Next on the DOGE insurance agenda is integrating coverage currently provided via job-based insurance, with the massive savings from eliminating tax subsidies to companies for insurance premiums redirected to the new payment agency. Any funds needed beyond projected savings will derive from trims to tax cuts, said the source.

Congressional progressives were shocked, though pleasantly so. Senator Bernie Sanders said, “That’s spectacular. It’s the first big step toward Medicare for All! I’m so glad Mr. Musk finally endorses real efficiency. I will work with him, if he’s serious about this.”

The plans were leaked initially from a health policy chat room in Signal.

Comment:

By Jim Kahn, M.D., M.P.H.

A few days ago, HJM warned about DOGE’s dismantling of federal health capacity. Now there is a truly pleasant surprise: a sheep in wolf’s clothing. “Unified Financing” is what single payer is all about. Consolidation of sprawling federal healthcare financing streams set the stage for administrative simplification, elimination of costly intermediaries, and standardization of comprehensive coverage. A huge step forward … we then just need to bring in people insured at work and of course the uninsured.

How is it possible that Elon Musk pivoted in this way to a favorite policy of progressives? Is the “E” in “DOGE” now to be taken seriously? – using government reform to eliminate waste and foster efficiency? Did PayPal provide the technical expertise needed to achieve payment reform?

Alas, it seems impossible. For those still asking “Can this be true?” I remind them, it’s April 1 – April Fool’s Day. This vision for Musk and DOGE is a prank. In these tumultuous times, I hope you’ll forgive – even enjoy – a short satire break.

The fact is, single payer IS efficient, as well as generous. We must keep spreading the word, and fighting for the proverbially (but not truly) elusive “free lunch” – we CAN get universal health care and save money, by focusing on health care justice and eliminating profiteering.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Hobbling Health & Human Services

The federal health department, DHHS, just announced major cuts and organizational consolidation, claiming improved efficiency and effectiveness. We see dangerously shifting priorities and a refusal to engage with the real causes of our ailing health system.

HHS Announces Transformation to Make America Healthy Again, U. S. Department of Health and Human Services, March 27, 2025

Today, the U.S. Department of Health and Human Services (HHS) announced a dramatic restructuring in accordance with President Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.”

Fact Sheet:

  1. The plan combines personnel cuts, centralization of functions, and consolidation of HHS divisions, including:
    • The current 82,000 full-time employees will be reduced to 62,000
    • 28 divisions will be consolidated to 15
    • 10 regional offices will become 5
    • Human Resources, Information Technology, Procurement, External Affairs, and Policy will be centralized.
  1. Regarding FDA, CDC, NIH, and CMS:
    • FDA [Food & Drug Administration] will decrease its workforce by approximately 3,500 full-time employees, with a focus on streamlining operations and centralizing administrative functions. This reduction will not affect drug, medical device, or food reviewers, nor will it impact inspectors.
    • The CDC [Centers for Disease Control & Prevention] will decrease its workforce by approximately 2,400 employees, with a focus on returning to its core mission of preparing for and responding to epidemics and outbreaks. …
    • The NIH [National Institutes of Health] will decrease its workforce by approximately 1,200 employees by centralizing procurement, human resources, and communications across its 27 institutes and centers.
    • CMS [Center for Medicare & Medicaid Services] will decrease its workforce by approximately 300 employees, with a focus on reducing minor duplication across the agency. This reorganization will not impact Medicare and Medicaid services.
  1. The consolidation and cuts are designed not only to save money, but to make the organization more efficient and more responsive to Americans’ needs, and to implement the Make America Healthy Again goal of ending the chronic disease epidemic.
  1. No additional cuts are currently planned, but the Department will continue to look for further ways to streamline its operations and agencies.
  1. A new Administration for a Healthy America (AHA) will consolidate the OASH, HRSA, SAMHSA, ATSDR, and NIOSH [in brief: access, workforce, equity; substance use & mental health; environmental toxins; occupational health], so as to more efficiently coordinate chronic care and disease prevention programs and harmonize health resources to low-income Americans. Divisions of AHA include Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce, with support of the U.S. Surgeon General and Policy team.
  1.  HHS will have a new Assistant Secretary for Enforcement to provide oversight of the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeal (OMHA), and the Office for Civil Rights (OCR) to combat waste, fraud, and abuse.
  1.  HHS will combine the Assistant Secretary for Planning and Evaluation (ASPE) and Agency for Healthcare Research and Quality (AHRQ) into the Office of Strategy to conduct research that informs the Secretary’s policies and evaluates the effectiveness of the Department’s programs for a healthier America.
  1.   The critical programs within the Administration for Community Living (ACL) that support older adults and people of all ages with disabilities will be split across the Administration for Children and Families (ACF), Assistant Secretary for Planning and Evaluation (ASPE), and Centers for Medicare and Medicaid Services (CMS).

HHS Announces Transformation to Make America Healthy Again, YouTube, by HHS Secretary Robert F. Kennedy Jr. (6 minute video)

Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

Be afraid. Be very afraid.

These changes may appear innocuous, just bureaucratic streamlining. However, name changes matter, reflecting major policy shifts. For example, “Substance Abuse” (in SAMHSA) and “Toxic” (in ATSDR) are gone from the new agency names and thus focus. Also, you can be sure that “equity” (an explicit HRSA mandate) is expunged from the new health agency mix.

It has not been revealed exactly who proposed the structural changes in “Transformation to Make America Healthy Again.” From prior media reports we suspect Elon Musk, senior advisor to the president and de facto head of the Department of Government Efficiency (which still lacks official status as a governmental agency) plus his unqualified employees, all tacking to the preferences of Secretary Robert Kennedy Jr. and President Donald Trump. Remarkably absent are qualified health care professionals and economists who place patients first. Soon on the scene as head of CMS will be Dr. Mehmet Oz who wishes to privatize Medicare with Medicare Advantage. (He has proposed “Medicare Advantage for All” but that won’t happen – and if it did would pale in comparison even to current Medicare Advantage.) We have no idea how the new agencies hope to reduce waste, fraud, and abuse … and the DOGE current track record bodes poorly.

Considerable damage will be inflicted on important existing programs. The planned cuts in personnel (and presumably resources) for the FDA, CDC, and NIH will reduce their essential services and harm us: riskier drugs, weaker public health, and diminished discovery research. RFK Jr states that he will establish a new “Administration for a Healthy America” (“Ah Ha”, he says) … but we have zero confidence that this carefully crafted phrase actually portends improved government organization to strengthen US health care services.

Not to mention our need for a universal, comprehensive, equitably funded, affordable health care system that we can all be proud of. In contrast to what RFK Jr claims, our over-spending and poor longevity have nothing to do with DHHS functioning. As we’ve discussed in HJM, the excess mortality is due to higher risk factors (including obesity, opioids, poverty, guns, and traffic accidents) and … worse health insurance! Recent surges in mortality reflect poor COVID response and lack of insurance. Our higher costs are due to massive administrative waste as well as high prices for drugs and procedures.

The new HHS will shift health care dollars from public health and patient care to tax cuts for billionaires.

As we said, be afraid, be very afraid!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.