The privatized Medicare Advantage (MA) system – which essentially overpays major insurance companies billions of taxpayer dollars every year – is likely to expand under a second Trump term.

Various policy proposals, including the Heritage Foundation’s Project 2025 blueprint that received so much attention during the campaign, call for making MA the default option for American seniors. This would go a long way towards weakening traditional Medicare and further enriching private insurance companies.

Trump’s nomination of Dr. Mehmet Oz to lead the Centers for Medicare & Medicaid Services (CMS) is a telling indicator. Oz has been a staunch booster of MA; his TV show featured a segment sponsored by a MA website, his YouTube channel recently posted a video that was essentially an ad for MA, and he holds hundreds of thousands of dollars in stock in MA providers.

During the campaign, Trump made promises to protect Social Security and Medicare. But the plan to further privatize Medicare seeks to end the public insurance program as we know it. As veteran journalist Robert Kuttner recently noted, the Project 2025 vision for Medicare Advantage as the default option is just the start:

“It then proposes a variety of other technical changes to give Medicare Advantage even less government supervision and more marketing advantages. While insurance companies don’t want relatively healthy seniors to leave Medicare Advantage plans, they are happy to let old and sick ones move to conventional Medicare. As people with complex conditions are denied care by Medicare Advantage, this begins a kind of death spiral of adverse selection in which the most costly patients are in conventional Medicare, which then reinforces the fake story that Medicare Advantage is more cost-effective.”

As CEPR has thoroughly documented, Medicare Advantage costs taxpayers more than traditional Medicare, does not improve health outcomes, and its denials of approval of necessary medical treatment has been a source of substantial frustration to patients, doctors and caregivers. The billions of dollars in excess payments currently going to private insurance giants could be used to bolster traditional Medicare, giving seniors broader access to care and nearly eliminating high out of pocket costs.

If the Trump administration plans to follow through on this plan to make MA the default choice for seniors, one should expect to see some political opposition. In December, Sen. Elizabeth Warren (D-Mass) and several other Democratic lawyers sent a letter to Dr. Oz questioning his advocacy for privatization:

“As CMS Administrator, you would be tasked with overseeing Medicare and ensuring that the tens of millions of seniors that rely on the program receive the care they deserve, including cracking down on abuses by private insurers in Medicare Advantage. The consequences of failure on your part would be grave. Billions of federal health care dollars – and millions of lives – are at stake.”