For more than a decade, Americans have been told that federal healthcare bureaucracies can reduce costs, improve care, and foster innovation if only they are given enough flexibility and authority. One of the clearest tests of that claim has been the Center for Medicare and Medicaid Innovation (CMMI), created under Obamacare to experiment with new payment and delivery models.
After 15 years, the results are in — and they are deeply disappointing.
CMMI was sold to the public as a narrow, experimental body that would test small-scale demonstrations, discard failures, and scale only those models that clearly saved money without harming patients. Instead, it has evolved into something far more troubling: a semi-autonomous policymaking engine capable of reshaping large portions of the healthcare system with minimal congressional oversight and little evidence of success.
Rather than reducing waste, CMMI has added to it. Independent evaluations have repeatedly shown that the agency has failed to generate the promised savings, instead contributing billions in additional costs to Medicare. That alone should prompt serious scrutiny. But the deeper concern goes beyond dollars and cents.
CMMI increasingly operates as a vehicle for implementing sweeping healthcare policies that Congress has not explicitly approved.
This is a fundamental accountability problem. In a constitutional republic, major policy changes — especially those affecting one-sixth of the economy — should be debated, legislated, and approved by elected representatives. CMMI’s structure allows unelected administrators to bypass that process by labeling broad policy shifts as “demonstrations.”
That was never the intent of the law, and it should concern Americans across the political spectrum.
Nowhere is this overreach more evident than in CMMI’s latest initiatives, including the Global Benchmark for Efficient Drug Pricing (GLOBE) and Guarding U.S. Medicare Against Rising Drug Costs (GUARD) models. These proposals would effectively import foreign price-control schemes into Medicare by tying U.S. drug prices to those set by governments in single-payer healthcare systems.
This is not experimentation. It is policy imposition.
Price controls have a long and well-documented history of failure. While they may appear to reduce costs in the short term, they ultimately discourage innovation, reduce competition, and limit access to new treatments. In healthcare, these consequences are especially severe. Every drug that is not developed because the economics no longer make sense represents potential treatments — or cures — that patients will never receive.
Supporters of these models often argue that drastic measures are necessary to address rising drug prices. That concern is understandable. Affordability matters. But using a little-known agency to impose foreign pricing regimes on American patients is neither transparent nor wise.
It also risks destabilizing one of Medicare’s most successful programs: Part D.
Medicare Part D has long stood as an example of how market-based competition can deliver value. Seniors consistently report high satisfaction, costs have come in well below projections, and access to medications has expanded. This success did not happen by accident. It resulted from competition among private plans, clear rules, and predictable incentives.
Recent changes under the dishonestly named “Inflation Reduction Act” already threaten that balance. Layering CMMI-driven price controls on top of those changes would further undermine the program’s stability, creating uncertainty for insurers, providers, and patients alike.
The broader pattern is clear. CMMI has drifted far from its original purpose and now functions as an unaccountable expansion of government control over healthcare decisions. Its growing budget, limited transparency, and poor performance record raise serious questions about whether it should continue to exist in its current form — or at all.
Public opinion reflects this concern. Voters increasingly recognize that CMMI has failed to deliver on its promises and that its expanding authority poses risks to patient choice and innovation. Americans want waste reduced and care improved — not more bureaucracy standing between doctors and patients.
Healthcare reform should focus on empowering patients, encouraging competition, and fostering innovation. That work is best done by the private sector, guided by clear laws passed by Congress, not by bureaucratic experimentation conducted without meaningful oversight.
Fifteen years is more than enough time to judge a program’s effectiveness. CMMI has had its chance, and it has not delivered. Continuing to double down on a failed experiment only compounds the damage.
If lawmakers are serious about eliminating waste, restoring accountability, and protecting access to high-quality care, they should rein in — or dismantle — CMMI and refocus healthcare policy on approaches that respect markets, innovation, and constitutional governance.
Government experimentation is no substitute for accountability. And when it comes to healthcare, Americans deserve better than quiet power grabs disguised as pilot programs.
George Landrith is the President of the Frontiers of Freedom Institute and the author of “Let Freedom Ring… Again: Can Self-Evident Truths Save America from Further Decline?”
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