When Dr. Joseph Sakran appeared on “The Dr. Oz Show” in 2018, he saw an opportunity to rally support for smarter gun policies.
The segment was brief and carefully choreographed, but the show’s host, Dr. Mehmet Oz, didn’t shy away from framing gun violence as a “public health crisis.” He lent Sakran and his fellow guests a platform to promote “This Is Our Lane,” a campaign to mobilize doctors and nurses around gun safety advocacy. The name was something of a clapback at the National Rifle Association, which had chided healthcare professionals to “stay in their lane” on gun policy.
Fast forward six years, and Oz is now President Donald Trump’s pick to lead the Centers for Medicare and Medicaid Services, a federal agency that plays a significant if often underappreciated role in gun violence prevention. The nomination has Sakran and other doctors worried: Since the 2018 segment, Oz has become a gun rights proponent, and his likely ascension to the head of CMS comes as Trump and congressional Republicans are eyeing cuts to Medicaid, which pays for treating most gunshot victims and funds programs to prevent shootings.
“I worry about my patients,” said Sakran, who was shot as a teenager and is now a trauma surgeon at Johns Hopkins Hospital and the chief medical officer at the gun reform group Brady. “Some of the patients that are getting these services are some of the most marginalized and vulnerable patients that we take care of.”
Oz’s Flip-Flop
Oz has said little publicly about his views on Medicaid. Elon Musk, tapped by Trump to find ways to cut federal spending, has “homed in” on Medicaid and CMS, potentially placing coverage for 70 million Americans at risk. On February 12, House Republicans unveiled a budget plan to cut billions of dollars from the public insurance program.
The White House and Oz did not respond to requests for comment, and the Senate Finance Committee has not yet scheduled Oz’s confirmation hearings, where senators will have the opportunity to ask how Oz may approach Medicaid and the issue of gun violence.
Dr. John Maa, a trauma surgeon in California, said anyone who has worked in a trauma center like Oz has seen the brutal reality of gun violence up close.
“I hope that he’ll remember his basic roots as a physician, and that it will guide him with a deeper understanding of the severity of the problem, which has only grown,” Maa said. “It has been a hope for me personally that he might remember the injuries and patients that he cared for.”
Oz had for years been a promoter of gun safety policies supported by a majority of doctors. He urged Congress to fund gun violence research and co-authored a 2019 op-ed that called for banning assault weapons and instituting universal background checks. On his show, he praised red flag laws as a measure to protect families and prevent mass shootings by allowing authorities to temporarily take guns from people a court deems dangerous.
But in 2022, as he fought through a crowded field of conservative candidates to win the Republican primary in Pennsylvania’s U.S. Senate race, Oz began opposing the very measures he once advocated. “When people say I won’t support guns, they’re dead wrong,” he said in one campaign ad, before loading a shell into a shotgun and firing.
Berwood Yost, director of the Center for Opinion Research at Franklin and Marshall College, said Oz’s reversal on gun policy may have hurt his general election campaign. “He was viewed as really not authentic, whether it was his changing positions on gun control or abortion rights or even his recent move to the state,” Yost said. “All of those things suggested a lack of authenticity.”
Oz went on to lose to Democratic Senator John Fetterman.
Treating Shooting Injuries
Gun violence strains emergency and trauma departments nationwide. The cost of treating shooting injuries in hospitals is estimated to exceed $900 million a year. Medicaid and Medicare cover about 60 percent of that price tag, a number that only accounts for initial hospital visits and patients being readmitted within six months.
The true cost of gun violence is more difficult to calculate and likely much higher. That’s because Medicaid not only covers hospital bills, but it’s also the primary payer for long-term care in the United States, covering most survivors whose shootings left them with chronic disabilities.
Medicare, the insurance program for older Americans, also pays out millions each year because of gun violence. Americans 65 and older have higher rates of firearm suicide than any other age group, and while most attempts are fatal, many survive and require medical treatment or rehabilitation.
Medicaid, which largely covers low-income Americans, plays such a large role because of the outsized impact of gun violence on poorer communities. Maa said he worries that changes to Medicaid could harm the people most at risk of gun violence.
“If there are cuts, then it’s going to have repercussions that we can’t even anticipate at this time,” Maa said. “The profound impact on health leads to housing insecurity and financial concerns. There would be long-lasting repercussions.”
While House Speaker Mike Johnson has said Republicans are focused on ridding Medicaid of fraud and imposing work requirements on beneficiaries, achieving the $2 trillion in spending cuts they’re hoping for would require slashing Medicaid significantly.
Dr. Kyle Fischer, an emergency physician and policy director for the Health Alliance for Violence Intervention, a nonprofit advocacy group, said there may be reason for cautious optimism about having a physician lead CMS despite Oz’s views on guns and the Trump administration’s broader moves on Medicaid.
“Every doctor in the country knows that Medicaid payment rates are critically important for patient access and for providers to keep their doors open,” Fischer said. “I have some hope that Dr. Oz, as a physician, knows how important these payments are.”
At the same time, Fischer said he worries that Oz may back the Republican push for stricter eligibility requirements and other new barriers for patients trying to access Medicaid coverage.
“I am concerned that Dr. Oz will support some of these barriers,” Fischer said. “But I hope that as these things come up, he’ll do the right thing.”
Preventing Violence
In 2021, in one of the Biden administration’s early moves on gun violence, CMS greenlit states to cover violence intervention programs based in hospitals. These programs typically employ violence interrupters and case managers to help shooting survivors navigate the health care system and escape cycles of violence through mentorship, conflict mediation, and other crisis interventions.
Supporters of these programs say they save lives — and money in the long run — but some Republican members of Congress oppose using Medicaid to fund them. With Oz poised to lead CMS, he could back proposals to specifically slash their funding or institute broader cuts that ultimately hit the programs.
“I worry that Oz being head of CMS could roll that back significantly,” said Sakran, the trauma surgeon.
Still, it could be difficult for the federal government to stop states from covering violence intervention. The federal government pays for at least half of Medicaid costs, but some states — particularly those in the South, where rates of gun violence are highest — receive far more federal funding. Federal law establishes minimum requirements for Medicaid coverage, setting a floor rather than a ceiling for what states must cover to receive matching funds. States can then choose to expand their coverage beyond those requirements to include optional services like violence intervention.
Since 2021, nine states have passed laws or enacted policies to provide coverage for violence intervention. Michigan became the most recent state to approve such a measure in December.
“The momentum has already started and is happening in a number of states,” said Dr. Chethan Sathya, a pediatric trauma surgeon and director of Northwell Health’s Center for Gun Violence Prevention. “But there are a number of states that have not implemented this at all, and I think for those states, it’s probably just not going to happen during this administration.”
Still, Sathya said he doesn’t think anyone knows exactly where Oz stands on Medicaid issues, so it’s impossible to predict how the program might change under his leadership.
“There’s so much unknown about him,” he said. “We have to see how it pans out.”
