On February 16, 2017, the Senate Finance Committee held a hearing to discuss the nomination of Seema Verma to be the Administrator of the Centers for Medicare and Medicaid Services (CMS). The hearing provided a little bit of insight into her plans for Medicare and Medicaid reform, should she be approved by the full Senate.
Ms. Verma did not offer many specifics on what types of reforms she will pursue, and she did not react to the recently-proposed CMS rule on market stabilization. She was particularly non-committal about the prospect of a Medicare premium support model and expressed enthusiasm for changing Medicaid, expressing a desire to attain better outcomes while noting multiple policy options available. Verma also discussed drug prices and praised the current negotiating abilities of pharmacy benefit managers and plan sponsors in Part D.
Chairman Orrin Hatch opened the hearing by complimenting Ms. Verma and her work on the Healthy Indiana Medicaid waiver plan, while Ranking Member Ron Wyden expressed concerns about Ms. Verma’s conflicts of interest and ability to lead CMS in a direction that benefits all Americans.
Ms. Verma stood up for herself and her past, noting that she has devoted her career working on policy for the most vulnerable Americans, and that she started her career by working on healthcare solutions for those affected by HIV/AIDS. She further noted that she wants to put the power to make healthcare decisions in the hands of the patients, along with pledging to modernize CMS and combat fraud.
Medicare
A topic that has received much discussion, whether Medicare and other government plans should be able to negotiate their own drug prices, was touched upon by Senator Debbie Stabenow. Verma did not really answer the question directly, instead noting that under her direction, CMS would do everything in its power to get affordable prices for seniors. She further noted her appreciation for PBMs and the Part D program that are already performing that function to the best of their ability.
Senator Bill Nelson asked Ms. Verma whether she would turn Medicare into a voucher program. She explained that it is not her intention, and that she is more interested in giving beneficiaries the choices and options they deserve.
Medicaid
Several of the senators were concerned about various aspects of Medicaid. Senator Robert Menendez expressed concerns that, if the Affordable Care Act were repealed, many children with autism would lose access to vital treatment and therapy. He asked Ms. Verma what she would do to protect their care, and she stated she had actually been advised by the Office of Government Ethics to refrain from engaging in matters related to mental disorders and care, due to a conflict of interest with her husband’s child psychiatry practice.
Senator Maria Cantwell shared “grave” concerns about block granting Medicaid and wondered how Ms. Verma would handle such a proposal. Ms. Verma noted that Medicaid does not currently encourage innovation due to its rigidity, and that the system needs to be rebalanced to allow more state leadership and flexibility for creativity. She stated that any reform would focus on ensuring better outcomes for patients.
Senator Sherrod Brown asked Ms. Verma to work with state Medicaid directors and encouraged her to have open communications with them. Ms. Verma seemed receptive to the idea, further agreeing with Senator Brown that CHIP funding should be extended for at least eight more years, in line with what HHS Secretary Price recently threw his support behind.
Senator Tim Scott asked for policy ideas that would work best to strengthen Medicaid on a state level. Ms. Verma noted that what works in one state may not work in another, that there is no one-size-fits-all solution to Medicaid that would be applicable to all fifty states.