Barring Senate confirmation, the Biden health care team is nearly complete. The only major pick left is the Commissioner of the Food and Drug Administration (FDA), which is down to two choices, according to The New York Times.
One major piece of the puzzle was recently put into place when President Biden announced his pick for Administrator of the Centers for Medicare and Medicaid Services (CMS). Chiquita Brooks-LaSure, who most recently worked as a managing director for Manatt Health, was tapped to lead the $1.2 trillion agency that oversees 63 million Medicare beneficiaries and 74 million Medicaid beneficiaries and employs 6,300 people. Brooks-LaSure was on Biden’s HHS agency transition review team.
LaSure will join potential HHS Secretary Xavier Becerra, Rachel Levine, MD, Assistant Secretary of Health at HHS, Vivek Murthy, MD, Surgeon General, and the FDA Commissioner, who will all need to be confirmed by a Senate that has a paper-thin Democratic majority (thanks to the tiebreaker from Vice President Kamala Harris). Other top members of Biden’s health policy team include those who do not need confirmation: Rochelle Walensky, MD, head of the Centers for Disease and Control and Prevention (CDC); Micky Tripathi, head of the Office for the National Coordinator of Health IT (ONC); Jeffrey Zients, former director of the National Economic Council, as the COVID-19 coordinator; Marcella Nunez-Smith, MD, Founding Director of the Equity Research and Innovation Center (ERIC) at the Yale School of Medicine, who has been charged to lead a taskforce on reducing health disparities; and Liz Fowler as director of Center for Medicare and Medicaid Innovation (CMMI).
Read more: Biden’s HHS secretary pick Xavier Becerra holds promise to reduce care disparities
The Senate will begin its hearing on Becerra as HHS Secretary this week. The choice faces opposition from some Senate Republicans and faith-based advocacy groups, Bloomberg reports, and isn’t guaranteed.
Brooks-LaSure is familiar with Obamacare and helped implement the monumental health law as she held the role of deputy director for policy at the Center for Consumer Information and Insurance Oversight within CMS during the Obama administration. Prior to that role, she assisted House Democrats, including then Rep. Becerra, in getting the law (as well as the Medicare Improvements for Patients and Providers Act of 2008) passed in Congress.
What do health care CEOs need to know about someone who would be the second most powerful health official in the Biden administration?
- She has written numerous policy papers on how to expand coverage via the ACA. Not only did Brooks-LaSure play an integral role in getting Obamacare passed in Congress and then implementing it as part of the Obama administration, but she has since written numerous papers on how to expand coverage through the ACA. Last year, on the 10th anniversary of the health law, she wrote a commentary for Health Affairs espousing various strategies to “expand comprehensive coverage to all low-income Americans and increase coverage affordability for middle-income Americans.” This includes options for lowering premiums, such as extending tax credits to people with incomes above the current eligibility threshold, increasing the generosity of tax credits for those currently eligible, and making reinsurance permanent. She also talked about extending federal assistance for cost sharing to people with incomes above the current threshold. With the Democrats in control of Congress and Biden in the White House, Brooks-LaSure may get the chance to enact some of these policies to expand ACA coverage.
- Specifically, Medicaid expansion could be a focus in her CMS. Of particular interest to Brooks-LaSure over the years has been the expansion of Medicaid enrollment, as part of the ACA. This past year, thanks to the COVID-19 pandemic, she has written that it is the right time to expand the program. She wrote a paper in May of 2020 saying that “in light of skyrocketing uncompensated care costs battering already financially fragile hospitals and health centers in rural communities throughout the country,” the 12 states who have yet to expand Medicaid should consider doing so. In the same paper, she also recommended expanding Medicaid for those without health insurance for COVID-19 testing and testing-related services. The Biden administration has begun efforts to remove work requirements, put in place by the Trump administration, that would tie into Medicaid enrollment. Over the years, she has written numerous reports on how states can implement a “Medicaid buy-in” program or potentially its own public option model. On the latter, President Biden campaigned on adding a public option onto the ACA, a measure that would require Congressional approval.
- A proponent of health equity. Brooks-LaSure is a monumental choice to lead the agency as she would be the first-ever Black woman running the agency. Along with Becerra and others, she would be part of a diverse team of leaders within HHS that will aim to reduce health inequity, which was another focus of Biden’s campaign for President. Based on her past, this seems to be an issue she is passionate about. In November of last year, Brooks-LaSure, along with three others, authored a piece for Robert Wood Johnson Foundation’s State Health and Value Strategies program, “State Strategies for Overcoming Barriers to Advance Health Equity.” The paper goes through the structural, institutional, political, financial and analytic challenges to achieving health equity and issues recommendations on how state leaders can take charge in solving the issues. The authors suggest “new programs and changes to existing initiatives across public health, Medicaid, and the Marketplace” that can improve equity. In a similar vein, she wrote a paper on how maternal health crisis is disproportionally impacting Black and American Indian/Alaska Native women. As CMS administrator, Brooks-LaSure would have the opportunity to oversee programs that could reduce these kinds of disparities.
- Billing and pricing. Beyond her interest in expanding health insurance coverage and improving equity, Brooks-LaSure’s beliefs on other policy topics are not as widely disseminated. One issue that she has spoken about, however, is surprise billing. As law firm Akin Gump Strauss Hauer and Feld writes, she is a member of the board of Fair Health, which is a non-profit focused on bringing transparency into health care costs and reducing the practice of surprise billing. In a 2019 webcast for National Conference of State Legislatures, Brooks-LaSure offered potential policy solutions that could protect consumers from surprise billing. She highlighted the fact that many state-level laws have been implemented and were ahead of federal efforts. That has begun to change as part of the stimulus bill signed in December that included surprise billing reform. It required that patients pay no more than the in-network sharing amount for out-of-network care and enacted a 30-day open negotiation period for providers and payers to settle out-of-network claims. Brooks-LaSure would have a role in regulating these rules as CMS Administrator. On the same state legislators webcast, Brooks-LaSure also outlined potential policy proposals that would curb the cost of prescription drug pricing, another area she’ll be able to tackle as CMS administrator.
- Her nomination has won approval from various advocacy groups. Lastly, a number of health care lobbying groups are encouraged by Brooks-LaSure’s nomination. Here are a few:
- American Hospitals Association President and CEO Rick Pollack: “Her previous experiences as a senior CMS and HHS official who helped implement the Affordable Care Act and her work on the House Ways and Means Committee gives her a deep understanding of the importance of health care coverage and protections for consumers. She is well equipped to lead CMS and we look forward to working with her to defeat the COVID-19 pandemic and advance the health of all our patients and communities.”
- Mark Leahey, President and CEO of the Medical Device Manufacturers Association (MDMA): “Chiquita Brooks-LaSure has an extensive and diverse background working at CMS, as well as in Congress to reform policies that impact the ability of patients and providers to access the cures and therapies developed by America’s innovation ecosystem.”
- Federation of American Hospitals (FAH) CEO Chip Kahn: “There is no better person to lead CMS during this pivotal time than Chiquita Brooks-LaSure. With more than two decades of experience in health policy, she will bring to the Administrator’s role a keen understanding of what it will take to lead our nation’s health care system out of the COVID crisis and beyond. Her past roles at CMS, HHS and on Capitol Hill make her uniquely qualified to step in and have an immediate impact. Brooks-LaSure was one of the architects of the Affordable Care Act and is an expert on the Medicaid program – she understands how important attainable health coverage is to keep people healthy.”
- Emily Stewart, Executive Director, Community Catalyst: “We applaud President Biden for choosing Chiquita Brooks-LaSure as leader of CMS. From her leadership positions in the Obama Administration and on Capitol Hill to her work with states, Chiquita Brooks-LaSure has a strong reputation as a leader who understands what people need from our health system and what needs to change to advance health equity in our country. We are eager to support her efforts to make Medicare and Medicaid work better for all people, and call on the Senate to swiftly confirm her appointment.”