Jeffrey Grant, who recently retired as operations director for the Center for Consumer Information and Insurance Oversight at CMS, delivered a compelling keynote address on Thursday at RISE National 2025, shedding even more light on the key developments during the first seven weeks of the Trump Administration and their significance.
He described the current situation as "a tale of two governments," noting a division between those aiming for normal policy transition and those seeking to attack the government. It's the best of government and the worst of government, he said.
“As a career person, you look for an incoming administration to have people with policy preferences that they have principles, that they govern according to those principles that they have, that they understand statutes, they understand regulations, and they do their regulations within the statutes. If the regulation doesn't allow them to do what they want to do, they go through a process to change the regulations through notice and comment rule -making that everybody in this room has probably got experience in commenting on rules and things. That is how the best of governance works.”
But the other side of government is made up of people who want to dismantle programs, he said. Because the newly formed Department of Government Efficiency (DOGE) was an unofficial arm of government, it was rolled into the US Digital Services, a unit made up of young tech experts who came in to help save HealthCare.gov. “They were really young, brilliant tech people, just like DOGE, with a difference that they’re coming into government to make tech work for government and make government run better.”
US Digital Services is now known as DOGE and is made up of new people with the same level of expertise but who don’t think the government can work and want to tear it down, Grant explained. “It's a totally different attitude. It's people that probably have had bad experiences in their encounters with government. Maybe they were regulated on something, but it is just a very energetic group of people that are engaged in tearing things down,” he said.
One of the worst decisions made was terminating the jobs of probationary workers, according to Grant. He said the employees who worked for CMS were highly productive, effective and had low salaries. Because DOGE wants to reduce the CMS workforce and contracts, these workers were unfairly fired. Grant says he believes that the courts will rule in favor of those Maryland employees as soon as Friday. Indeed, shortly after his presentation on Thursday morning, a federal judge ruled that the Treasury and the Veterans Affairs, Agriculture, Defense, Energy and Interior departments must reinstate employees who had been improperly terminated so a similar ruling may occur in the Maryland case.
As for upcoming health policy, Grant said he isn’t sure what Trump wants to do with health care but Robert F. Kennedy Jr., the new secretary for the Department of Health and Human Services, is more focused on the National Institutes of Health, the Food and Drug Administration, and the Centers for Disease Control and Prevention and making America healthy again. Grant predicts that Dr. Mehmet Oz will become the new administrator of CMS following his confirmation hearing on Friday, and that he’ll take the lead on health policy. Based on his background, Grant said that Oz will be more favorable to Medicare Advantage and focused on quality of care and costs.
Meanwhile, he recommends that health care professionals continue to learn and read about health policy and the movers and shakers of the industry. Among them, Brian Blasé, president of Paragon Health Institute and former special assistant to the president of economic policy at the White House’s National Economic Council, and Grant’s former boss, Peter Nelson, deputy administrator and director at CMS who formerly served as senior policy fellow at Center of the American Experiment, a conservative think tank. The two men don’t always see eye to eye, but Grant said Blasé has a lot of thoughts on the market and Paragon will push health policy ideas. In addition, Grant suggested attendees subscribe to Health Affairs, the Politico Pulse podcast, attend RISE conferences to learn and network, and be a lifelong learner.