Senate Finance Committee Holds Confirmation Hearing For Top Biden HHS Nominees

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Deputy Secretary and CMS Administrator Picks Would Fill Two Critical Policy Positions
 
On Thursday, the Senate Finance Committee held a confirmation hearing for two of the most important health policy officials nominated by President Biden, Chiquita Brooks-LaSure (Administrator, Centers for Medicare and Medicaid Services) and Andrea Palm (Deputy Secretary). These are two critical policy positions for Congress to help fill, as the Deputy Secretary is often comparable to the Chief Operating Officer of a cabinet agency and the CMS Administrator helms the implementation of public health programs that cover well over 100 million Americans.
 

Both are Obama Administration veterans with substantial health policy experience in the public sector that includes stints as health policy aides on Capitol Hill, the Department of Health and Human Services (HHS), the Office of Management and Budget (OMB). They have also served as a private-sector health policy consultant (Brooks-LaSure), and as Secretary-Designee in the Wisconsin Department of Health (Palm). Ms. Brooks-LaSure was a senior Biden-Harris Transition Team leader for the Department of Health and Human Services and, if confirmed, will be the first African-American woman to oversee the enormous Medicare and Medicaid programs. She noted that her first time in the Finance Committee hearing room was when she was an intern while in graduate school. Ms. Palm most recently helped the Governor of Wisconsin by overseeing the state’s COVID-19 response.

The hearing was less confrontational than some other confirmation hearings in the health policy area, reflecting Senators’ respect for the backgrounds and experience of the two nominees. A wide variety of topics were covered in Senators’ questions, including Medicare, Medicaid, drug pricing reform, Graduate Medical Education, Telehealth, and Community Health Centers. Below is a summary of the key points discussed by the nominees in response to the panel’s inquiries.

Opening Statements

Chairman Ron Wyden (D-OR)

  • The Chairman noted the extensive experience both nominees will bring with them to these positions, if confirmed. In listing a number of hot button health policy issues that will be a focus of the Finance Committee, Chairman Wyden named COVID-19, Medicare and Medicaid, health care disparities, and called for a “revolution” in mental healthcare access.

Ranking Member Mike Crapo (R-ID)

  • Sen. Crapo noted his strong interest in having Medicare and Medicaid beneficiaries enjoy the same telehealth access as private insurance holders after the pandemic subsides. He called for a bipartisan approach to reforms and warned against using the budget reconciliation process to ram through changes when there is a chance they could all work together to facilitate innovation and shore up the Medicare program’s stability. He opposes using drug pricing reform budgetary savings to pay for some of the President’s proposals to expand federal health insurance programs.

Andrea Palm

  • Ms. Palm is eager to find common ground on several issues, including: (1) increasing access to Medicaid and Medicare by strengthening benefits and expanding care; (2) lowering prescription drug costs; (3) ensuring global leadership in research, development, and innovation; and (4) prioritizing the key role of HHS in advancing the health and wellbeing of children.
  • If confirmed, she pledged to work in a bipartisan manner with Congress on expanding the access and flexibility of telehealth for all communities with the intent to also close health disparities in underserved communities.

Chiquita Brooks-LaSure

  • Ms. Brooks-LaSure committed to making sure that CMS programs work better together and remain the pillars of our health care system by supporting patients, their families, and providers, including communities of color that have been hardest hit by the pandemic.
  • If confirmed, she is committed to working to expand access to innovative therapies, procedures, and models of care. She noted that innovation is only effective if patients can afford it and she will work with Congress to rein in health care costs, including for prescription drugs.

Public Option

Chairman Ron Wyden (D-OR) discussed Sec. 1332 of the Affordable Care Act and how it assists states in promoting a public option to increase competition. Ms. Brooks-LaSure committed to working with states on different options for expanding coverage and wants CMS to be an open door for new ideas on how to do this.

Medicaid

Sen. Michael Bennet (D-CO) spoke about children with complex medical needs that are unable to receive professional services in their state. He asked Ms. Palm if she would work on a timely implementation of the Advancing Care for Exceptional (ACE) Kids Act to ensure better care coordination across multiple providers and ease regulatory burdens across state lines. Ms. Palm responded that she looks forward to implementing this law over the next year. On Medicaid state waivers, Ms. Brooks-LaSure testified that she will include states in decision-making related to waivers.

Telehealth Policy

Telehealth issues arising during the hearing included reimbursement rates and the use of phone only or audio services. Sens. Maria Cantwell (D-WA), Catherine Cortez Masto (D-NV), and Mike Crapo (R-ID) expressed an interest in these subjects. Ms. Brooks-LaSure is willing to consider higher reimbursement rates, but noted that there is a need for safeguards to ensure that medical services are actually being delivered in all instances where telehealth is billed. She also agreed to work on coverage for the phone/audio-only option.

Mental and Behavioral Health Policy

Ms. Brooks-LaSure said she is committed to ensuring that CMS is integrated with other parts of HHS, like the Substance Abuse and Mental Health Services Administration, to tackle the mental and behavioral health issue holistically.

Drug Pricing Reform

When Sens. Chuck Grassley (R-IA) and Tom Carper (D-DE) mentioned the issue as a priority, Ms. Brooks-LaSure testified that she is focused on lowering prices for innovative medicines and that she wants to work with the committee to lower prescription drug prices in a bipartisan manner.

Surprise Billing

When asked about surprise billing, Ms. Brooks-LaSure testified that she will work hard to implement the No Surprises Act this year and said that being confirmed quickly would help.

Health Equity

Ms. Brooks-LaSure responded to a question from Sen. Sherrod Brown (D-OH) that health equity will be a priority of hers. Ms. Palm testified that the American Rescue Plan Act included major steps toward increasing health care access but “we can’t stop there.”

340B Drug Program

In response to a question from Sen. John Thune (R-SD), Ms. Palm said that she is aware of the critical role of this program for safety net providers and low-income communities. She said she looks forward to ensuring the appropriate oversight for this program and will follow its legislative intent.

Graduate Medical Education

In response to comments from Sens. Sherrod Brown (D-OH) and Bob Casey (D-PA), Ms. Palm testified that the Children’s Hospitals Graduate Medical Education Program remains a priority for the new Administration and she said she will work with them on this program. When Sen. Bob Menendez (D-NJ) asked about ensuring a smooth implementation of the allocation of new Medicare-funded GME slots, Ms. Brooks-LaSure said she understands the intent to have these slots go to underserved areas and she wants CMS to have an open dialogue with public notice and comment where stakeholders can engage.

Community Health Centers

In response to a question from Sen. Tom Carper (D-DE) about how to leverage Community Health Centers to address health disparities, Ms. Palm noted that while in her role at the Wisconsin Department of Health Services, she saw first-hand how critical partnerships with community health centers in areas like behavioral health and health care shortages became an asset.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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