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From Health Law Daily, February 16, 2017

Nominee for CMS Administrator big on flexibility in policy, payment reform

By Kayla R. Bryant, J.D.

Seema Verma, President Donald Trump’s nominee for CMS Administrator, appeared before the Senate Finance Committee for her confirmation hearing this morning. Sens. Orrin Hatch (R-Utah) and Ron Wyden (D-Ore) opened the hearing with their prepared statements. Hatch emphasized the need for imminent health reform, with a focus on Medicaid program growth and solvency concerns about the Medicare trust funds. While he lauded Verna’s role in shaping Indiana’s Medicaid expansion policy, Wyden questioned possible conflicts of interest surrounding that work.

Personal history. In her opening statement, Verma emphasized how her personal experiences have shaped her opinions and passion for health care policy and the United States at large. She noted that her career began working on national policy for those with HIV and AIDS, and that she worked as an advocate to improve birth outcomes for low-income mothers. She spoke of watching her mother and four-year-old neighbor fight cancer, and lauded the excellent medical care available in the U.S. that allowed both to survive these battles. She also emphasized the importance of the "American dream" by illustrating the opportunities her parents were able to pursue, her father as an immigrant and her mother as the first woman in her family to receive a graduate degree.

Policy. In her statement, Verma pledged to pursue policies to make health care more patient-centered, allowing patients and their providers to choose from a wide variety of options about their care, emphasizing the need to provide choices and respect decisions made by those in vulnerable and low-income populations. Unsurprisingly, Verma mentioned the need to reduce the costs of care to sustain CMS’ programs while ensuring quality standards are met. She also indicated that states would have more of a voice in designing programs.

Questions. Medicaid financing is a hot topic in health reform and Verma agrees that the process should be revamped, but called for increased flexibility and remains open not only to block grants or per-capita caps, but all possible options to both improve health outcomes and hold states more accountable for their programs. When pushed about changes to the Medicare program, however, Verma said she does not support the idea of premium support. This plan, also known as a voucher system, would provide payments to beneficiaries who would in turn purchase private insurance or traditional Medicare coverage, has been proposed by HHS Secretary Tom Price and Speaker Paul Ryan (R-Wis). Verma spoke of her desire to preserve the program for her own children, but wants to find other ways to do so.

The theme of flexibility and choice carried over to the topic of mandatory payment demonstrations. Verma does not support forcing participation in demonstrations and thinks such projects must be thoroughly vetted before becoming policy—a stance that lines up with that of her potential boss, Secretary Price. Verma criticized accountable care organizations (ACOs) that require providers to take on more risk, which is difficult for small and rural providers. Despite a suggestion that she supports retaining fee-for-service, she maintained that there were issues with both types of payment models.

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