Trump Team Rolls Out Three-Front Health Care Cost Push: Medicare Billing Fix, ACA Fraud Purge, Drug Price Deals

The Trump administration is running three healthcare cost-cutting plays at once, and the timing, weeks before the midterms, is not an accident.

The Medicare Double-Billing Fix

CMS Administrator Dr. Mehmet Oz is finalizing a rule to stop doctors from charging Medicare recipients twice on the same day. Right now, a doctor can bill a separate "evaluation and management" fee, worth more than $235, on top of a procedure fee when both happen in one visit, according to the Daily Signal. Think a dermatologist checking a mole and removing it in the same appointment.

An HHS Office of Inspector General audit found 42% of Medicare beneficiaries getting intravitreal eye injections were hit with this same-day double charge, per the Daily Signal. The proposed fix cuts the initial exam fee to 50% when it's bundled with a same-day procedure. California and Florida, home to roughly 10 million Medicare beneficiaries combined, stand to benefit most. The rule closed its public comment period in mid-September and CMS is expected to finalize it, with a January effective date, right after the midterms.

Not everyone's on board. The American Hospital Association, representing 5,000 member hospitals, sent CMS a letter opposing the change, arguing it "would result in more fragmented care and reduced access for patients," even while saying it appreciates CMS targeting inappropriate duplicate billing. Cutting a fee providers currently collect twice could change how they structure same-day visits.

Oz Takes Aim at Medicare Advantage

Speaking Tuesday at an event hosted by the Better Medicare Alliance, an MA industry lobby, Oz compared the program to "a garden" that's "vulnerable to weeds and overgrowth," according to Healthcare Dive. More than 35 million Americans, over half of Medicare's senior population, are enrolled in Medicare Advantage plans this year, drawn by lower upfront costs and extra perks like dental coverage and gym memberships.

But the federal government will spend an estimated $76 billion more on MA this year than it would under traditional Medicare, according to research cited by Healthcare Dive, partly because insurers exaggerate how sick their members are to pull in bigger reimbursements, a practice known as upcoding. Trump has called insurers "money sucking" in past remarks. Oz's rhetoric signals continued scrutiny, but CMS has yet to announce a specific enforcement action against MA insurers.

760,000 ACA Enrollees Cut Over Fraud Claims

The biggest and most contested piece: Vice President JD Vance announced Tuesday that the administration is removing 760,000 people, covering roughly 315,000 enrollments, from ACA marketplace plans, saying they were fraudulently enrolled or don't exist, according to reporting from NPR, Minnesota Public Radio and WABE, all citing the same Associated Press account. Vance, who runs the administration's fraud task force, said the move saves $2.2 billion. Another 419,000 enrollments face additional verification. CMS is also suspending new insurance agents and brokers for six months, since officials say brokers accounted for a disproportionate share of the fraud found.

Vance's case: if the government wasn't checking eligibility before, and hundreds of thousands of enrollments turn out to be duplicate, fake, or unqualified, cutting them saves real taxpayer money on a program covering 19.2 million Americans. That's a straightforward fraud-prevention argument, and nobody in these sources disputes that fraudulent enrollees shouldn't be on the rolls.

The pushback is about process, not principle. Cynthia Cox, a vice president at KFF who directs its ACA program, told reporters, "I think there's no question that somebody who was fraudulently enrolled should have their coverage canceled," but added, "the question is whether this was the appropriate process by which to identify fraudulent enrollees, and also whether all of them were indeed fraudulently enrolled." Cox noted the removals happened outside the normal regulatory process. Ellen Montz, who ran CMS's insurance oversight center under the Biden administration, said fraud reduction efforts were already underway before this announcement.

None of the three outlets carrying this story—NPR, MPR News and WABE—all working from the same AP wire report, published independent verification of how CMS identified the flagged enrollments or what error rate, if any, exists in the process. The administration says $2.2 billion saved and 760,000 fraudulent enrollees found, but there's no public audit trail showing how many of those 760,000 people, if any, were legitimately enrolled and got cut anyway.

Drug Price Deals Keep Coming

On a fourth track, the administration announced most-favored-nation pricing deals on August 31 with nine more mid-sized drugmakers, including Teva, CSL, Sun Pharma and UCB, bringing the total to 26 manufacturers covering 89% of the brand drug market, according to the law firm Mintz. The companies commit to offering Medicaid programs discounted rates matching prices in other developed countries, plus a combined $19.6 billion in U.S. manufacturing and R&D investment. In exchange, the manufacturers get exemptions from future pricing mandates and potential tariffs under Section 232.

The catch: none of the announcements specify which drugs are discounted or by how much. The announcements don't clarify whether any of these drugs will show up on TrumpRx.gov, the administration's direct-to-consumer purchasing platform, or what the deals actually mean for commercial insurers and pharmacy benefit managers who aren't part of the agreement.

What's Next

CMS is expected to finalize the Medicare same-day billing rule in the coming weeks, with a January 2027 start date. Whether the ACA verification process for the remaining 419,000 flagged enrollments turns up more confirmed fraud or reinstates people wrongly cut remains an open question that neither Vance's announcement nor the current reporting has answered.