Two Senior CMS Officials on "Saving Costs" - June 2026

MedCityNews, June 9, 2026 (Katie Adams): CMS Dr. Oz on Making Healthcare Affordable
https://medcitynews.com/2026/06/dr-oz-cms-healthcare-affordability/

MedCityNews, June 8, 2026 (Katie Adams): Casey Mulligan on Healthcare Cost Incentives
https://medcitynews.com/2026/06/hhs-affordability-healthcare-costs/

For experts, these two pieces in MedCityNews are less “two cost-control plans” than two different levels of the same policy stack. Oz is giving the CMS administrator’s operational/political affordability agenda: fraud, drugs, IT, prevention, deregulation. Mulligan is giving the HHS economist’s causal theory of cost growth: distorted incentives, especially Medicaid financing mechanics, propagate through the whole system.

Core thesis of each

Oz: CMS can make care more affordable by attacking visible sources of excess cost and friction: fraud, waste, drug prices, antiquated claims infrastructure, chronic disease burden, and regulatory overhead. His framework is program-administrative and public-facing: identify large “fixable” domains and mobilize CMS authority around them.

Mulligan: Healthcare costs are not primarily a coverage problem; they are an incentives problem. He wants policy analysis to separate health, healthcare, and insurance, and to ask who pays, who benefits, and what behaviors are induced. His concrete target is Medicaid provider taxes and state-directed payments, which he portrays as fiscal machinery that inflates spending and spills over into commercial premiums, wages, Medicare, and taxpayers.

Where Oz and Mulligan overlap

They overlap most strongly in diagnosis by incentives rather than entitlement expansion. Neither frames affordability as “more insurance coverage” or “larger subsidies.” Both emphasize that current financing and administrative structures generate avoidable cost.

They also overlap on patient control and information, though with different emphases. Oz’s app-library and interoperability discussion points toward consumer access, portability, and data liquidity. Mulligan’s version is more economic: patients need data, price transparency, genuine choices, and freedom to compare competing medical claims.

They share a deregulatory skepticism toward legacy systems. Oz criticizes quality-measurement burden and welcomes a 10-for-1 deregulatory mandate. Mulligan, as chief regulatory officer, focuses on regulatory impact analysis: measuring costs, benefits, distributional effects, and incentive consequences.

They also both imply that federal healthcare costs are embedded in cross-market systems. Oz says Medicare fraud alone could dramatically affect the trust fund. Mulligan says Medicaid payment games spill into commercial prices, employer premiums, wages, Medicare spending, and taxpayers. Both reject siloed accounting.

What is unique to Oz

Oz’s agenda is broader and more operational. His five buckets are:

1. Fraud, waste, and abuse — especially DME in South Florida, hospice clustering in Los Angeles, and personal care services employment in New York and California. His Covid-era point is politically important: emergency spending and weak tracking taught new actors that healthcare fraud was accessible.

2. Drug pricing reform — especially Most Favored Nation pricing, with a claimed $600 billion ten-year savings estimate, plus GLP-1 access for certain Medicare beneficiaries with obesity-related conditions at $50/month.

3. Technology modernization — replacing Medicare’s COBOL-based billing infrastructure with cloud systems, plus the Medicare App Library and data-sharing networks.

4. Preventive health and nutrition — especially obesity and chronic disease, nutrition education in medical schools, and revised dietary guidance.

5. Deregulation and measurement reform — less faith in quality-measure proliferation, more concern about administrative burden.

Oz is therefore speaking as an agency head trying to communicate a portfolio: enforcement, payment policy, IT modernization, prevention, and deregulation.

What is unique to Mulligan

Mulligan’s piece is narrower but more theoretically pointed. His distinctive contribution is the “supply-side health economics” frame: do not confuse insurance expansion with health improvement or cost reduction. He wants to analyze delivery-side incentives.

His most concrete policy target is Medicaid provider taxes plus supplemental/state-directed payments. The mechanism he describes is:

States tax hospitals, nursing homes, or managed-care plans; use the revenue to draw down federal matching dollars; then return funds to providers through supplemental or state-directed payments. Mulligan argues this is not benign fiscal plumbing. It changes provider incentives, increases the cost of delivering care, shifts resources, raises commercial prices and employer premiums, affects marketplace premiums and wages, and even spills into Medicare.

That is the more technical article. It is less about “CMS can modernize X” and more about “federal-state financing arbitrage creates systemwide price inflation.”

Do they disagree?

There is no direct contradiction in the excerpts. The articles are complementary, not adversarial.

The closest tension is one of emphasis:

Oz says major savings can come from fraud enforcement, drug pricing, modernization, prevention, and deregulation. Mulligan says the deeper affordability problem is incentive design, especially financing mechanisms that inflate provider payments and prices.

A second mild tension is that Oz’s agenda includes some expanded access/payment policy, such as cheaper GLP-1 access for Medicare beneficiaries with obesity-related conditions. Mulligan’s lens would ask whether that policy improves health enough to justify costs and what incentives it creates. But the excerpt does not show Mulligan criticizing GLP-1 coverage, and Oz frames it as affordability/access.

A third tension is philosophical: Oz’s prevention-and-nutrition discussion is clinician-population-health oriented; Mulligan’s is economist-incentive oriented. Oz talks about chronic disease burden and medical education. Mulligan talks about regulatory impact, price spillovers, and financing distortions. These are different explanatory languages, not contradictions.

Expert read: what this signals

Together, the articles suggest a Trump-era HHS/CMS affordability message built around five themes:

First, anti-fraud enforcement will be framed as trust-fund solvency policy, not just program integrity.

Second, drug pricing remains central, especially through international reference-pricing rhetoric.

Third, CMS modernization is being cast as cost policy, not merely IT housekeeping.

Fourth, chronic disease prevention is being absorbed into affordability policy, with nutrition and obesity as cost drivers.

Fifth, Medicaid financing reform may become one of the most consequential technical battlegrounds, because Mulligan is explicitly tying provider taxes and state-directed payments to commercial premium inflation, employer costs, wages, Medicare spending, and federal taxpayer exposure.

For a policy expert, Mulligan’s piece may be the more important tea leaf. Oz lists the visible agenda. Mulligan identifies a technically specific target with large distributional stakes: the provider-tax/supplemental-payment ecosystem. If HHS acts on that theory, hospitals, states, Medicaid managed care plans, and employer purchasers will all care deeply.

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DR OZ ON SAVING COSTS

The 5 Areas Where Dr. Oz Says CMS Can Make Healthcare More Affordable

https://medcitynews.com/2026/06/dr-oz-cms-healthcare-affordability/

CMS Administrator Dr. Mehmet Oz outlined the agency's strategy for making healthcare more affordable during a Tuesday address at the HFMA Annual Conference, touching on everything from Medicare fraud to drug pricing to nutrition.

Dr. Mehmet Oz

CMS Administrator Dr. Mehmet Oz is optimistic about Washington’s ability to bend the healthcare cost curve, he said during a Tuesday address at the HFMA Annual Conference in National Harbor, Maryland.

“It’s not all rosy, but there’s some opportunities. As a clinician, I’ll tell you, if you have an opportunity to fix a problem, it gives you more hope than if you think the issue is terminal. We’re definitely not terminal,” he declared.

During his talk, Dr. Oz outlined a few key areas that CMS is targeting to make healthcare more affordable. Below are the main pillars of the agency’s affordability agenda.

Fraud, waste and abuse

Eliminating fraud from the Medicare program alone would double the trust fund’s lifespan without raising taxes, Dr. Oz argued.

He cited examples of large-scale fraud cases that the federal government has busted in recent months — an outsized number of durable medical equipment suppliers in South Florida, a disproportionate share of the country’s hospices concentrated in Los Angeles, and inflated personal care services employment in New York and California. 

“Much of this started during Covid, because what we taught fraudsters in Covid was, we’re going to give a lot of money away from the federal government, and we don’t really have a way of tracking it, so we can’t really tell if you used it the right way, and we can’t get it back if you didn’t. Because of that, we brought a lot of people into the health ecosystem who never thought of defrauding healthcare before — but now that they know it’s possible, they’re loving it,” Dr. Oz remarked.

Drug pricing reform

Dr. Oz highlighted the Most Favored Nation pricing initiative, which requires pharma companies to charge Americans no more than what developed countries pay abroad. He projected that the policy will result in $600 billion in savings over 10 years. 

He also noted that Medicare beneficiaries with obesity-related conditions will be able to access GLP-1 medications for $50 per month starting July 1.

Tech modernization

CMS is replacing Medicare’s COBOL-based billing system with a cloud platform, marking the first upgrade in more than 50 years. Dr. Oz said this change will speed up how Medicare processes and adjudicates claims.

He also noted that CMS launched its Medicare App Library in April, which seeks to create a more consumer-driven, app-based health data infrastructure.

Under the initiative, patient data doesn’t stay siloed within individual apps. Instead, participating companies connect to CMS-backed data-sharing networks — including health information exchanges and interoperability frameworks — that allow data to flow directly into clinicians’ workflows. Nearly 800 health tech companies have signed onto the initiative, Dr. Oz said.

Preventive health and nutrition

The country’s high chronic illness burden — particularly obesity — has a huge impact on rising healthcare costs, Dr. Oz pointed out.

To help fix this, CMS is working to embed nutrition education into medical school curricula. Dr. Oz noted that more than 50 schools have pledged 40 hours of nutrition training.

“The problem is that we don’t teach people going through their training about things like nutrition, so they don’t think they matter. It turns out if you want to deal with the chronic illnesses that drive at least 70% of all healthcare costs, you have got to be able to address basic realities of preventive medicine, including nutrition,” he remarked.

Dr. Oz also cited the recently revised food pyramid as a meaningful step toward correcting decades of flawed dietary guidance that he said has contributed to the obesity crisis.

Deregulation

Under a White House executive order, CMS must eliminate 10 regulations for every new one it introduces.

Dr. Oz said he welcomes this mandate. He argued that much of the current quality measurement apparatus creates administrative burden without actually improving care. 

“Not everything that you can measure matters, and not everything that matters can be measured,” he stated.

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Casey Mulligan on Saving Costs

https://medcitynews.com/2026/06/hhs-affordability-healthcare-costs/

HHS Affordability Czar Says Healthcare Costs Stem From Incentives, Not Coverage

Healthcare affordability czar Casey Mulligan laid out the economic philosophy guiding the Trump administration's approach to healthcare costs during a recent conference address. He argued that provider taxes and state-directed payments inflate healthcare spending far beyond Medicaid and ultimately raise costs for employers and taxpayers.

By Katie Adams on June 08, 2026 8:24 pm

Healthcare spending is one of — if not the largest — financial burdens facing Americans, federal health regulator Casey Mulligan said during an address on Monday at the HFMA Annual Conference in National Harbor, Maryland.

HHS Secretary Robert F. Kennedy Jr. appointed Mulligan as chief economist and chief regulatory officer of the agency in April. Mulligan said that his work at the agency focuses heavily on how to make healthcare more affordable — and that this requires a focus on healthcare delivery, not just insurance coverage

He uses a framework he refers to as “supply-side health economics” — which insists that healthcare, health outcomes and health insurance are distinct concepts.

“Yes, insurance matters, but it’s not the endpoint. The endpoint is better health and lower costs with more control in the hands of patients and families,” Mulligan declared.

In his eyes, policymakers spend too much time debating insurance coverage and not enough time addressing the underlying drivers of patient outcomes and healthcare costs. Moving forward, he thinks patients should have more information and control.

Mulligan believes patients need access to their own health data, transparent information, genuine healthcare choices and the freedom to evaluate competing medical claims.

He described one of his primary responsibilities as conducting regulatory impact analysis. To do this well, he thinks policymakers should carefully measure costs and benefits — as well as who bears those costs and how incentives are created by policy decisions.

As part of his work at HHS, Mulligan has closely examined provider taxes and state-directed payments.

He argued that many states use a financing mechanism in which they tax hospitals, nursing homes, or managed-care plans, and then this tax revenue is used to draw additional federal Medicaid matching funds. Mulligan said the combined funds are usually returned to providers through supplemental payments or state-directed payments.

“Medicaid financing gimmicks spill over to commercial prices, employer premiums, marketplace premiums, wages and Medicare spending,” he remarked.

Mulligan argued that these financing arrangements end up driving up healthcare costs far beyond Medicaid. And he believes provider taxes typically increase the cost of delivering care, while supplemental Medicaid payments encourage providers to shift resources toward Medicaid patients. 

Together, these dynamics put increased pressure on commercial insurance premiums and Medicare spending, he said. 

Mulligan contended that limiting these arrangements would help lower healthcare costs for taxpayers.

For him, addressing healthcare affordability requires policymakers to focus less on insurance coverage and more on the incentives that actually shape how healthcare is financed and delivered.

Photo: Malte Mueller, Getty I