One senior Department of Government Efficiency (DOGE) staffer is reportedly trying to shield the Center for Medicare and Medicaid Innovation (CMMI) from mass layoffs and budget cuts, according to a recent Politico expose. That’s a shame. If there’s any agency in Washington that deserves to be cut to the bone—or eliminated entirely—it’s CMMI.
CMMI—much like Obamacare, which created the agency—has consistently failed to deliver on its promises. Proponents pledged that CMMI would design and test new payment structures that reduce taxpayer spending and improve the quality of care that patients receive.
But over the past decade and a half, CMMI has consistently increased the financial burden on taxpayers, with little benefit for patients or providers. And it has routinely grabbed far more power for itself than almost anyone envisioned.
It’s time for the Trump administration, the newly confirmed head of the Centers for Medicare and Medicaid Services Dr. Mehmet Oz, and Congress to end one of Obamacare’s worst experiments. And since CMMI is projected to increase net federal spending by $1.3 billion over the 2021-2030 timeframe, zeroing out the agency’s budget could even help pay for Republicans’ reconciliation bill.
In March, the Centers for Medicare and Medicaid Services—CMMI’s parent organization—announced it would discontinue four CMMI payment models by the end of the year due to cost overruns and disappointing performance. According to CMS, ending these models earlier than previously scheduled will avoid wasting $750 million in taxpayer funds.
Those four models are the latest entries in a lengthy ledger of failures. Over CMMI’s first decade, only four out of 49 payment models—a mere 8%—met the agency’s own criteria for expansion.
Collectively, those models reduced healthcare spending by $2.6 billion, but cost $7.9 billion to design, implement, and operate—meaning CMMI increased net federal spending by over $5 billion.
The models largely haven’t improved patient outcomes. For instance, CMMI commissioned a review of its Primary Care First Model and found “limited evidence the reported changes in care delivery have improved outcomes, relative to outcomes at other similar primary care practices.”
The biggest concern with CMMI isn’t the consistent failure to achieve its stated goals, though. After all, plenty of government agencies overpromise and underdeliver.
Rather, the deeper problem is that CMMI has claimed unprecedented authority to implement sweeping changes to Medicare and Medicaid. Congress envisioned that CMMI would conduct small scale tests to improve the healthcare system at the margins. But in many cases, the agency has imposed, or tried to impose, nationwide mandatory payment models on tens of thousands of doctors and hospitals—and tens of millions of patients.
Consider the most infamous of these power grabs, which came at the tail end of the Obama administration. In March 2016, CMMI proposed fundamentally changing the way Medicare Part B reimburses for medicines administered in doctor’s offices, clinics, and hospitals. The alterations would have reduced oncology clinics’ revenue by billions of dollars—thereby threatening to disrupt care for many Americans battling cancer.
The Obama administration ditched that plan only after President Trump won the 2016 election. But Democrats never abandoned their support for CMMI itself. At the time, then-Speaker of the House Nancy Pelosi called it a “valuable tool” in unilaterally changing the healthcare system.
There’s no question that Medicare and Medicaid are fiscally unsustainable and require major reforms. But that reform ought to come from Congress—not a few hundred unelected and unaccountable bureaucrats. It’s time for Republicans to deprive the left of this expensive and uncontrollable tool once and for all.
