“This is Donald’s room,” Phyliss Shobe says as she ushers me into the neat, spare room where the 81-year-old retiree has covered almost every available space with MAGA memorabilia. Arrayed on the bed, there’s the Gulf of America shirt she got for a friend, as well as a Trump calendar, a Melania book, a fake American Express card identifying her as a charter member of the 2020 Republican Presidential Task Force bearing Trump’s signature, and of course, the “MAGA King” hat she was wearing when I first met her last year at a Trump rally in Richmond, Virginia. When I arrive at her house, Shobe apologizes for not having a cake ready for my arrival. She bakes cakes for everyone, including her doctors, but a family emergency the night before had kept her out of the kitchen. She’s dressed up for the occasion, her nails expertly painted purple. She’d gone to the hairdresser that morning. Shobe’s home, 20 miles south of Richmond, is modern but comfortably cluttered with her well-organized collections of elephant figurines, antique tea cups, and other “junk,” as she calls it. The “junk,” however, can’t possibly compete with the spread in Donald’s room. When we enter the shrine, Shobe narrates a tour with the confident delivery of a professional docent. She points out the special shelves her son designed to display more Trump tchotchkes than I’ve ever seen outside of a Trump rally. There’s the iconic photo of him, bleeding, with his fist in the air after he was shot at his Butler, Pennsylvania, rally in 2024. Christmas ornaments, glasses and coffee mugs, lighters, bottle openers, coasters, and every sort of pin are laid out with care, not a speck of dust on them. The 2024 Trump “revenge tour” gold coin takes center stage on one shelf, along with a Make American Great wristwatch. Trumpy Bear presides on a little chair in the corner. Looking around her sanctuary with pride, Shobe assures me, “This is all going to be treasure someday.” Shobe is what you might call a Trump superfan. She’s one of the 96 percent of Republicans who strongly supported Trump in 2024 and who, according to an AP-NORC poll, still believe Trump has been a great president. They’re the folks who’ve stuck with him through his mismanagement of the Covid pandemic, his impeachments, his various criminal prosecutions, and the January 6 insurrection. Typically white, Christian, over 65, and less likely than most Republicans to have a college degree, MAGA voters like Shobe are a small but vocal minority. They make up only about 15 percent of all American voters and about a third of all Republicans, according to a 2024 study by researchers at the University of California Davis. But they’re devoted. As Trump’s erratic tariffs threaten the economy, federal health and safety agencies have been gutted, and the military has been deployed to corral peaceful protesters who oppose his immigration tactics, his overall approval rating has plummeted in less than six months. Only 38 percent of Americans approve of the job he’s doing, according to a June poll. Yet Trump’s support among Republicans like Shobe has remained sky high—nearly 90 percent still strongly approve of his performance.   A shelf of badges, pins, and other Donald Trump collectables.Stephanie Mencimer/Mother Jones “I fight anybody that has anything bad to say about Donald Trump,” she told me before I went to visit her in March. “I just admire the man so much for what he goes through and put up with when he didn’t have to.” She’s not alone among her cohort. “All my friends are true believers,” she says. But have Trump’s marital infidelities, for instance, ever dimmed his star in her eyes? Maybe the allegations that he paid hush money to porn star Stormy Daniels? “What goes on in his personal life,” she says, is between him and his wife. “As long as it doesn’t affect the American people.” What about the New York City civil jury that found that Trump had sexually abused E. Jean Carroll in a department store dressing room? Shobe, like more than 90 percent of Trump’s 2020 voters, simply doesn’t believe it. And don’t get her started on January 6, which she knows was caused by government agitators; otherwise, the Capitol Police would never have let it happen. Many Democrats and now even some Republicans are a bit bewildered by people like Shobe, for whom Trump really can do no wrong. The diehards who make up Trump’s base tend to get parodied in the media and dismissed as cult members. But after covering Trump for nearly a decade now, I’ve learned that his most devoted fans are often far more complicated than the stereotypes suggest. Shobe is no exception. Look beyond her MAGA hats and “Missed Me?” T-shirts and it’s clear that a whole confluence of things have brought her to this place. She’s had a difficult life and one that more often than not, the government has done little to ease, regardless of who was in office. And she is deeply unsettled by the rapidly changing world that manifests in everything from the George Floyd protests to gender fluidity— and especially in the recent influx of immigrants. “Donald is sending ’em back,” she adds approvingly, explaining that she sees him as a stabilizing force, someone who will put an end to all the madness. Shobe is so committed to Trump that last year when he finally staged a rally near her house, she made the pilgrimage, even though she was battling what she called “Mr. C”—cancer. I met her as she was waiting to go inside the Richmond Convention Center with her brother and sister-in-law, all three using walkers. She was wearing a one-of-a-kind Trump T-shirt, so I asked if I could take her picture. She happily agreed but told me to wait so she could hide a bag full of urine under her shirt. She didn’t want it to show up in the photo. Not long after the rally, she had her kidney removed along with part of her bladder and went through several rounds of chemotherapy. (She’s now in remission.) While she was recovering, Shobe had to stow all her Trump merch so that a live-in caregiver could stay in the spare bedroom. When the woman left after a month, Shobe was relieved, and not just because they argued about politics. As her son told her, “You can have Donald Trump’s room back.”  Phyliss Shobe in her Trump room.Stephanie Mencimer/Mother Jones Much of her collection is bounty from the political donations she’s made over the past five years, mostly in $20 or $50 increments, which have netted these expressions of gratitude from a host of GOP luminaries. “I got a message from Trump that says he loves me,” she says, beaming. Alongside autographed Christmas cards from Trump, there are others from Texas Governor Greg Abbott and Rep. Elise Stefanik (R-NY). “I can’t find the DeSantis one,” she laments. > “I got a message from Trump that says he loves me.” Shobe doesn’t want to say how much money she has donated to political campaigns, but she’s given to various Trump committees, the Republican National Committee, and MAGA congressional candidates: Hershel Walker in Georgia, Dr. Mehmet Oz in Pennsylvania, former House Speaker Kevin McCarthy’s race in California, Blake Masters in Arizona, and former Ohio Sen. JD Vance among them. As a prolific small donor, Shobe is part of a trend. A 2022 paper from the National Bureau of Economic Research found that the number of voters from both parties donating $200 or less grew from 5.2 million in 2006 to 195.0 million in 2020. Meanwhile, the average size of a contribution plummeted, from $292.10 to $59.70. Those small donors, like Shobe, tend to be the most ideological voters in the country, and their donations are a major driver of political polarization. Richard Pildes, an NYU law professor and campaign finance expert, told the New York Times in 2023 that Trump-supporting House Republicans who voted against certifying the Electoral College count on January 6, 2021, received an average of $140,000 in small contributions in the 2022 midterm elections. Republicans who voted in favor of the peaceful transfer of power received only an average of $40,000. Donald Trump signed portrait, left, and a Donald Trump-themed stuffed bear.Stephanie Mencimer/Mother Jones In that sense, Shobe’s modest donations add up to a lot of influence for a senior from “chicken country” in Moorefield, West Virginia. “I’m just a dumb hillbilly,” she tells me with a laugh. On the wall in her TV room is a photo circa 1958 showing the inside of the one-room log cabin where she first attended school. Pointing out a picture of Jesus on the classroom wall, she asks, “You wouldn’t see Christ in a classroom now, would you?” Shobe has never been wealthy. Her working life started at age 13 when she moved in with West Virginia State Senator Don Baker (D) to take care of his children. Baker died shortly after taking office, and his wife Betty got elected to his seat. Shobe stayed with her until she graduated from high school in 1961. Then she moved to Washington, DC, sharing a crowded apartment with other girls from her high school drawn to the city for jobs. After bouncing around between Maryland, West Virginia, and DC, she eventually moved to Virginia to do typesetting for the Masons. In the late 70s, she got stomach cancer that was misdiagnosed and left her in and out of hospitals for three years. The fraternal organization took care of her. “They paid my rent and everything,” she told me. Among her other many jobs, she helped Israel “Izzy” Ipson, a Lithuanian Holocaust survivor, work on his memoirs. He would record his thoughts on tape, and Shobe would transcribe them and clean up his English. “He was a lovely man, oh my,” she told me. “That’s why I don’t like to hear people cutting down Jewish people.” Her work with him contributed to a 2004 book, Izzy’s Fire: Finding Humanity In The Holocaust, by Nancy Wright Beasley. (Ipson’s son Jay founded the Virginia Holocaust Museum in Richmond.) > “He loves getting to us uneducated people. I knew he couldn’t be bought.” Shobe had been a Trump fan on some level since the ‘80s when he was a brash young real estate developer. He “is a nice-looking man,” she has told me more than once. And, of course, she watched him on “The Apprentice.” She got on board with his political ambitions as soon as he announced he was running for president in 2015. “He loves getting to us uneducated people,” she explains. “I knew he couldn’t be bought.” But she didn’t make her first campaign contribution until 2020 when she started reading “about the Federal Reserve” and watching YouTube videos with her friend Angie, who does hair. Since then, she’s been all in, driven by her anger about the direction the country is going. Shobe’s modest political donations have earned her eternal gratitude from GOP candidates—and an avalanche of fundraising calls, texts, and emails. Her landline rang nonstop while I was at her house. She showed me one fundraising email that claimed Trump has ended taxes on Social Security taxes—he hasn’t. Others contained invitations to become a “special member” of this or that exclusive Republican club. She has responded to a lot of them, answering polls from Elon Musk asking what hat he should wear to the Inauguration, and making small donations. As a result, she now owns an inch-thick stack of commemorative membership cards from everyone from now-Secretary of State Marco Rubio to Sen. Ted Cruz (R-Texas), all of which went into the shrine. Shobe says she is such a sought-after Trump supporter that she occasionally talks to Musk on the phone. I asked her how she knew it was the billionaire. “They know things about me,” she confided in a whisper. (AARP has warned that financial scams originating with phone callers claiming to be Elon Musk have become epidemic.)   “I just admire the man so much for what he goes through and put up with when he didn’t have to.” Hats, t-shirts, books and other Donald Trump collectables.Stephanie Mencimer/Mother Jones By the time I visited Shobe, Trump had already imposed aggressive policies well beyond what he did in his first term. Musk and his DOGE boys had dismantled the US Agency for International Development and sacked thousands of federal employees, including about 3,000 from Social Security. “How do you think Trump is doing?” I ask her. “I don’t know if he’s doing that the right way,” she replies earnestly. “I thought, ‘Oh Donald. Slow down a little.’” But mostly she’s thrilled with his presidency. I wondered if she knew about Musk’s effort to seize control of personal information the government held on Americans. She didn’t but she also didn’t care. “You know why it doesn’t bother me?” she asks with a laugh. “My bank account is empty.” > “I don’t know if he’s doing that the right way. I thought, ‘Oh Donald. Slow > down a little.’” When I arrived, Shobe had just gotten off the phone with the bank, trying to recoup money that had mysteriously vanished from her account. Her credit card numbers have been stolen multiple times. “There isn’t anything out there that’s secret,” she says. I mentioned that Trump had shuttered the Consumer Finance Protection Bureau, the only federal agency whose mission was to protect Americans from financial scams. She’d never heard of it but conceded that it was a good idea. Her brother lost $17,000, his life savings, after getting a call from someone claiming to have kidnapped his grandson. Shobe may not know about Trump’s destruction of the CFPB, but she does know all about men in women’s sports, the 300-year-old people receiving Social Security who Musk “discovered,” the Covid “lab leak” theory, murderous immigrants, DEI ruining the FAA, and Hollywood’s involvement in child trafficking. I ask where she gets all her news. “Fox, Fox, Fox,” she says. “I don’t even turn to other channels.” Her media diet definitely does not include Mother Jones, which she didn’t realize was a liberal publication until after I arrived at her house. After the tour of Donald’s room, I took Shobe to lunch and her sister called while we were in the car. “You’ve reached the famous Phyliss Shobe,” she said, explaining that she was still busy with “the reporter.” “Do you know she’s a Democrat?” Shobe says in amazement. “Tell her to get out of the car!” her sister responds, before asking if Shobe was converting me to Trumpism. They both laugh and Shobe assures her that even though I’m a liberal, I’m still a nice person. We go to an Italian place near her house, and over a steak and cheese hoagie, she tells me more about her life. When Shobe was pregnant with her first child, her husband was in a bad motorcycle accident that left him unable to do manual labor. She worked to put him through college in another part of the state while she stayed behind to raise her two children. The strain was eventually too much, and they split up after 10 years. But her children did well and are now taking good care of her, even if they don’t necessarily share her enthusiasm for Trump. When Shobe was 50, the young daughter of a West Virginia friend was struggling. Shobe took in her baby, Tim, and raised him as her own. It wasn’t always easy. When she was on the night shift at a gas station, she’d push two chairs together for him to sleep on while she worked. She was never close with her father, but she went back to West Virginia to care for him for 18 months before he died at age 103—“The best thing I ever did.” Later, she took in her 95-year-old dying sister. “That’s how I tore up my body,” she says, explaining that she had to have her shoulder replaced after all the lifting. “But it was worth it.” Her family prided itself on its self-sufficiency. “We never got help from anybody,” Shobe tells me. “We gave help to people. We don’t believe in welfare.” > “We never got help from anybody. We gave help to people. We don’t believe in > welfare.” In that way, Shobe resembles the avid Trump supporters sociologist Arlie Russell Hochschild profiles in her new book, Stolen Pride, whom she calls the “elite of the left-behind.” She writes of discovering that “those most enthralled with Donald Trump were not at the very bottom—the illiterate, the hungry—but those who aspired to do well or who were doing well within a region that was not.” Shobe may have escaped poverty-stricken West Virginia long ago, but her roots there are still profoundly shaping her worldview in a way that’s masked by her current prosperity. Even her relatively new suburban lifestyle hasn’t shielded her from more trauma, however. In 2020, one of her two sons nearly died from Covid and was in a coma for a month. Not long after, Tim was shot in a drive-by outside a Roanoke nightclub. The bullet went through his arm and into his side, where it tore up his intestines and colon. Given all she’s endured, perhaps it’s not surprising that Shobe believes we’re in what evangelicals call the End Times. All the crazy weather from the changing climate? “That’s God,” she assured me, “trying to let the people know he’s coming.” After lunch, we return to her tidy bungalow in a 55-and older community. Inside, Tim is snoozing on the couch while his almost 2-year-old toddler naps nearby in a travel crib. We sit in recliners in the cozy den where Shobe watches Fox News, and she recommends some books to me by the controversial evangelical writer Sarah Young. She shows me her worn copy of Jesus Calling Devotions for Every Day. The phone keeps ringing. Iconic photo of Donald Trump after assassination attempt.Stephanie Mencimer/Mother Jones After listening to Shobe’s life story, I had to wonder why she wasn’t a Democrat. After all, the party’s platform revolves around helping people just like her, advocating better health care, supporting children, and opposing gun violence. As it turned out, she had a political shrine once before—for President John F. Kennedy. “I loved John Kennedy,” she says. “That was my first voting experience.” She also voted for Bill Clinton, though she thinks Hillary is “scary.” During the Obama years, Shobe says she wasn’t paying enough attention to know much about what he did in office. “He’s a Muslim, you know.” She’s also sure Barack and Michelle are getting divorced—there’s a YouTube video about that. As for former President Joe Biden, she feels only pity. “We watched [him] deteriorate in front of our eyes,” she tells me with a shake of the head. “I felt sorry for the man because his family let him go out there and embarrass himself and the country.” She isn’t necessarily opposed to voting for Democrats, it’s just that she has no idea what their agenda is. I suggest they are, among other things, trying to save Social Security, Medicaid, and Medicare. She’s unconvinced. Medicare costs for her have been going up even when Democrats were in office. And the Social Security office was almost impossible to reach on the phone before Trump was elected. She can’t imagine it getting much worse. The politics talk ends when the toddler awakens. Even though Shobe’s back is in bad shape, she picks him up and cuddles him. He’s already joining her Trump fan club. The dark-haired sprite loves Trumpy Bear and when he sees the president on TV, he will raise both arms and yell, “Go Donald!” Eventually, it’s time for me to go. I bid Shobe farewell and she invites me to visit again any time—and promises next time there will be cake. Since then, we’ve stayed in touch. One day in early June, I asked her if she knew Trump was making cuts to cancer research and the Veterans’ Administration, both things she cares about. “I’d have to read more about that,” she said skeptically. “I don’t think Donald is responsible for that.” The next day, she sent me this text: > “After we talked yesterday I thought about things you said and I have followed > Donald Trump for many years but when he and Melania came down those steps I > knew in my heart that this country needed those two people… So, I guess > nothing will change my opinion of my President I’m behind this couple one > hundred percent. I like you a lot and although we disagree on politics. I hope > we can stay in touch and be friends. I think we meet people for a reason. Just > think you might end up with all of my keepsakes. Ha! Ha!” Phyliss Shobe holds a Donald Trump t-shirtStephanie Mencimer/Mother Jones

When Gwen Williams’ mother was dying, taking her to an in-person appointment to get more medicine seemed impossible. So Williams made a telehealth appointment with the doctor—a video call. It was that easy. “Her comfort was paramount,” Williams, who lives in Minnesota, recounts. “My mother wasn’t conscious during the visit, but [the doctor] was able to see her and was able to get the hospice medications and everything refilled.”  Williams’ mother was on Medicare, as is she. Since 2020, Medicare has covered a wide range of remote medical services, some in critical situations like theirs, and others for routine care. Around one in four telehealth appointments are made by people on Medicare. > Around one in four telehealth appointments are made by people on Medicare. The fact that Medicare will abruptly cut off that coverage for most specialties on January 1—barely a month away—Williams said, “just blows my mind.” What we now call telehealth, an umbrella term for remote and digitally assisted medical care, was first developed by NASA in 1960 as a suite of tools to monitor astronauts’ health in space. While it has been gaining traction as a widespread, normalized aspect of care since the beginning of this century, telehealth really exploded in 2020 with the onset of the Covid-19 pandemic. Until then, for Medicare patients—which includes most Americans over 65, and some younger disabled people—remote care coverage had been limited. In rural areas, for instance, people on Medicare could speak to a non-local specialist via telehealth, but not from home; they still had to go to a local hospital to place the call. But on March 6, 2020, the Centers for Medicare and Medicaid Services temporarily expanded Medicare’s telehealth coverage to all specialties. That expansion, renewed in 2022, is set to expire at the end of the year, impacting more than 65 million Americans. Multiple bills have been introduced in the 118th Congress to preserve Medicare telehealth provisions and continue allowing people on Medicare to use telehealth flexibly, but all still await votes in both the House and Senate. Perhaps the likeliest to pass, the Telehealth Modernization Act of 2024, introduced by Rep. Buddy Carter (R-Ga.), received widespread, bipartisan support from members of the House Committee on Energy and Commerce and its subcommittee on health. “Seniors, individuals with mobility issues, and those living in rural areas rely on telehealth,” Rep. Carter said in a statement to Mother Jones, calling the act “critical legislation that will extend telehealth flexibilities to get Medicare beneficiaries the life-saving health care they need.” Where so many other health issues can be partisan or controversial, says Telehealth Access for America executive director Alye Mlinar, telehealth manages to be bipartisan. Mlinar hopes the bipartisan support “critical for really any issue” that telehealth has garnered will help lead to another congressional extension. Epilepsy Foundation chief medical officer Dr. Jacqueline French’s organization has supported telehealth access for people with epilepsy even before the start of the Covid pandemic. “There’s nothing that we learn from a physical exam that we could not learn from just talking to a person,” said French, who is also a professor of neurology at New York University Langone Health’s Comprehensive Epilepsy Center. The Epilepsy Foundation is one member of Telehealth Access for America, a consortium that includes, among other groups, the American Medical Association, Johns Hopkins Medicine and the National Down Syndrome Society. There are plenty of patients who can’t make long journeys at all—but for many others, telehealth is still a way to avoid travel risks. Traveling with uncontrolled seizures, for instance, can be dangerous, French notes. Even if Congress does not extend its current, wide coverage of telehealth for Medicare recipients, a handful of protections—mainly around dialysis, strokes, and mental health—would remain. Williams, whose mother also relied on telehealth, also praised the separate ways it benefits her: When the doctor who prescribed their mental health medication moved away, telehealth prevented a disruption in her care. She likens the often needless in-person visits to “a meeting that could have just been an email.” “Just have to have a conversation with your doctor,” Williams said, “paying for transportation, paying for parking if you drive—it’s a real barrier when all you need is to have a conversation, to continue care, or ask a question.” But there are limitations to a blanket extension of the program, argues Medicare Rights Center senior counsel Casey Schwarz.  “We had really hoped Congress would take the opportunity to look carefully at what a telehealth benefit could and should look like, because while the pre-pandemic status quo is inadequate,” Schwarz told Mother Jones, “A complete lack of restriction or breaks on telehealth services is also inappropriate, and we think has some risk for beneficiaries.” Schwarz said that she had heard from Medicare recipients “who have received what they believe to be substandard care through telehealth because something that they think would have been noticed or caught in an in-person visit was missed.” An investigation by Mayo Clinic researchers found that diagnostic accuracy for people on telehealth ranged from 77 percent for ear, nose, and throat doctors to 96 percent for psychiatrists across a 90-day period in 2020. However, specialists, such as rheumatologists, were more likely to request an in-person appointment to continue care, in comparison to primary care doctors.  Schwarz also says that telehealth cannot replace other forms of compliance with civil rights laws around accessibility, like the Americans with Disabilities Act. “We don’t want to see telehealth fill in a way for providers to indicate that they do not need to meet physical access requirements because they provide telehealth services,” she said. In-person services, especially from specialists, can’t always be replaced—and people like Schwarz raise the risk of telehealth, often cheaper for providers, being used to justify cuts to in-person services. Williams, for instance, does see their neurologists in-person, so they are able to assess her reflexes and the progression of their neuropathy. With just weeks until the end of the year and Medicare’s telehealth termination, there is not much time for individual bills to pass through Congress and be signed into law by President Biden.  Mlinar, however, is optimistic that an extension for Medicare telehealth recipients will be part of an annual end-of-year package negotiated by Congress “given the overwhelming support.” “The biggest question at this point,” Mlinar said, “is [for] how long.”

Some 15 percent of Americans are enrolled in Medicare Part D, which covers outpatient prescription drug costs for older adults and other qualifying individuals, providing nearly $140 billion a year in support to about 50 million people. But the program is administered by the Centers for Medicare and Medicare Services—which President-elect Donald Trump has nominated celebrity physician Mehmet Oz to lead. It’s questionable how a man infamous for promoting questionable supplements, who has commented that there’s no right to health for people who can’t afford it, will help lead and provide government health insurance in the United States. On his show, the cardiothoracic surgeon has mounted attacks on medications that Part D covers, such as antidepressants, claiming that they do not work for most patients (the evidence is against him). A Facebook post of Oz promoting myths and exaggerating the suicidality risk of people on antidepressants. Julia Métraux Given his history, it makes sense that Oz would be part of Trump’s “Make America Healthy Again” cohort, which does seem fairly anti-science: Robert F. Kennedy Jr.’s attacks on vaccines, for instance, also conveniently ignore that measles and polio can cause lifelong health conditions. Medicare Part D currently covers the costs of all recommended vaccines. But what kind of damage could Oz do from his new post? Will he be able to cut medications that actually help people manage chronic health conditions—conditions that people who qualify for Medicare are more likely to have? The short answer is no. At least not on his own. Juliette Cubanski, deputy director of health nonprofit KFF‘s program on Medicare policy, explains that the range of medications covered by Medicare Part D is specified in the Social Security Act. “Generally speaking, Medicare Part D covers drugs and vaccines that are approved by the Food and Drug Administration,” Cubanski told Mother Jones. “The law specifically excludes some types of drugs from coverage under Part D, including drugs used for weight loss or cosmetic purposes.” So dubious supplements that Oz promoted on his show could not readily be added to the list, nor could he easily remove actual medication. “Congress would need to change the law in order to change what drugs Medicare Part D covers,” Cubanski said. “An agency official acting under their own authority can’t do that.” There is still the possibility that some aspects of Medicare Part D could change through a regulatory process, says University of Pennsylvania health law and policy professor Allison Hoffman, but that too is a rigorous procedure—and attacking Medicare would also be a risky political move. “Medicare Part D was passed during a Republican administration and with Republican control in Congress, with Democratic support,” Hoffman said. “Trump knows to tread carefully in this space because Medicare is a widely popular program and the Part D program has really created a lot of financial security for people.” But if Republicans do, as they have pledged, go after the Inflation Reduction Act, which helped fund and improve Medicare affordability, Part D isn’t necessarily in the clear. The IRA instituted a new $2,000-a-year cap on out-of-pocket spending costs for prescriptions—still a lot for many older Medicare patients, and for qualifying younger disabled people, but an extremely short-lived protection if it’s immediately overturned by the GOP. And while Oz on his own can’t screw up Medicare Part D too badly, there’s no guarantee he’ll let it work smoothly, either. In practice, the plans are administered by private insurance companies, which can choose which pharmacies to work with and even which medications to cover. Federal health reforms like the Affordable Care Act have focused in part on making it harder for insurers to weasel out of providing care—not a likely priority for Trump’s health officials. If someone on Medicare needs to start a new medication, they could meet with a rude awakening. “That would require them to either switch to a different drug in the class, or switch plans during the next open enrollment period,” says Julie Donohue, chair of the University of Pittsburgh’s Department of Health Policy and Management. Such limitations in Part D—and related programs, like private-insurer-run Medicare Advantage plans—illustrate the consistent failures of privatizing Medicare, something Oz nevertheless pushed for more of during his unsuccessful 2022 Senate campaign. With the chaos and uncertainty that’s marked Trump’s White House nominations—like former Rep. Matt Gaetz withdrawing on Thursday from consideration to be his Attorney General—Hoffman also cautions us to “wait to see if people are confirmed,” rather than immediately panicking about “our imagination of what these policies might be.”