A Medicare minefield awaits Oz

• A burgeoning anti-big-business wing of the GOP is coinciding with growing concern among fiscal hawks about the program's significant cost and its reported overuse of prior authorization that adds hurdles to seniors' access to care.
• Their differences in opinions and priorities with Republicans who traditionally support privatized health insurance could complicate the Trump administration's vision of what's next for Medicare Advantage.

The big picture: Oz and the Trump administration are decidedly pro-Medicare Advantage and will likely continue to encourage seniors' enrollment in the program, said Philo Hall, a health care lawyer at Epstein Becker Green who worked at Health and Human Services during the George W. Bush administration.

• But they may do so in ways that insurance companies don't favor, such as by continuing to scrutinize how plans are paid for enrollees' illnesses, he said.

State of play: Oz doesn't have any experience with health insurance regulation but he's been a vocal supporter of Medicare Advantage.

• He's promoted the plans on his popular television show and said he'd expand MA offerings during his failed 2022 Senate campaign.
• His enthusiasm for the program falls into traditional GOP policy territory. Republican policymakers often cite the program's ability to give seniors more choices in their health care and private companies' ability to manage an insurance operation more efficiently than the federal government. (Many Democrats in Congress ardently support the program, too.)

Yes, but: In recent years, some Republicans in Congress have showed interest in changing the Medicare Advantage program in order to rein in overpayments to plans and require faster procedure authorizations.

• Paragon Health, a conservative health care think tank led by former Trump administration health official Brian Blase, earlier this year laid out a proposal for cutting Medicare Advantage spending.

A growing populist vein of the Republican party that helped deliver the electoral win for Trump could also spell trouble for the country's largest health insurers, many of whom are big players in the MA market, said Joel White, a GOP strategist and president of Horizon Government Affairs.

• "In general, the MAGA perspective is … big business tends to screw the little guy," White said. "And the big insurance companies are big, very big indeed."

Trump plans to put patients in charge of health care over health insurance companies, his transition team told Axios.

• "President-Elect Trump has repeatedly pledged to protect and augment Medicare benefits while also recognizing the need for reforms to our broken, inefficient, and costly healthcare system to increase access and decrease costs for everyday Americans," Liz Huston, a spokesperson for the Trump-Vance transition team, said in an email.
• The incoming administration will examine "every facet of the federal government's involvement in our healthcare system to address these priorities and goals," she said.

Reality check: Despite their populist rhetoric, the incoming administration's specific policy plans so far aren't particularly anti-big-company, said Craig Garthwaite, a professor at Northwestern University who researches the business of health care.

• The pharmaceutical industry could be the exception to that, given Robert F. Kennedy Jr.'s strong anti-pharma positioning, he added.

What to watch: Medicare Advantage leaders and industry watchers are confident the environment will be good for insurers.

• Shares of UnitedHealth Group, the largest MA organization, surged the day after Trump announced Oz as his pick to lead CMS.
• Oz "is a CMS administrator appointee who I think has been very vocal about what he sees as the opportunity for MA to do more," said Sachin Jain, CEO of nonprofit MA insurer Scan Health Plan.
• "What I'm hoping is that this will be a period of a lot of innovation in Medicare Advantage," he said.