Verma Completes First Confirmation Hearing to Head CMS

Seema Verma’s confirmation hearing to be Administrator of the Centers for Medicare and Medicaid Services (CMS) was held before the Senate Finance Committee last week. Her experience reforming the Medicaid program in Indiana was touted by Republicans on the Committee. Verma repeatedly stated her belief that that there is much room for improvement in the current Medicaid program through increasing flexibility for states to innovate in the administration of Medicaid. Like Secretary Tom Price did during his confirmation hearings, Verma reiterated support for access to affordable health care coverage while offering few details about how she would reform the Affordable Care Act (ACA) or the Medicare
program. She also did not give a definitive response when asked if she supports allowing the federal government to negotiate pharmaceutical prices. While Democrats expressed frustration that she did not provide enough specificity in her responses, the overall tone of the hearing was much more friendly compared to other of President Trump’s nominees. Chairman Orrin Hatch (R-Utah) said he plans to move the nomination quickly, and that he expects Verma to be confirmed. A committee vote on her nomination has not yet been scheduled.

Republican Bill to Protect Pre-Existing Conditions Introduced

Energy and Commerce Committee Chairman Greg Walden (R-Ore.) introduced The Pre-Existing Conditions Protection Act of 2017 (H.R. 1121) last week. The bill is aimed at preventing insurers from discriminating against individuals with pre-existing conditions through exempting certain services from their plans, and is intended to ensure that these individuals won’t pay more for their insurance due to their health status. But it is unclear how the legislation will prevent people from waiting to purchase insurance until they are already sick – the dilemma that the Affordable Care Act’s (ACA) individual mandate aimed to address. The issue of protections for pre-existing conditions was not contained in the recently released reconciliation blueprint because of Senate reconciliation rules – the measure must be moved through as a separate bill through regular order. H.R. 1121 currently has 42 Republican cosponsors.

Lawmakers Consider Medicaid Per-Capita Caps

House Republicans may restructure the Medicaid program through the use of per-capita caps, according to Vice Chairman of the House Energy and Commerce Health Subcommittee Brett Guthrie (R-Ky.). Under this policy, the program’s open-ended commitment from the federal government would be changed into a capped per-person payment to states. Per-capita caps would provide more flexibility to states than a block grant, but would still limit federal spending on the Medicaid program. The idea was previously included as a part of Speaker Paul Ryan’s (R-Wis.) A Better Way health care plan. The change would be included as a part of the forthcoming reconciliation bill used to repeal the Affordable Care Act (ACA). Several Republican senators, however, have expressed skepticism that an overhaul of the Medicaid program could pass at the same time as ACA repeal.

Freedom Caucus Positions Themselves on ACA Repeal/Replace

Last week, members of the House Freedom Caucus voted to oppose any Affordable Care Act (ACA) repeal measure that does not go as far as the version passed by Congress in 2015. The 2015 measure, however, repealed Medicaid expansion, which would be particularly difficult to pass the Senate given today’s political environment. Republican members from states that expanded their programs have expressed reservations about repeal due to concerns about constituents losing insurance coverage, especially in the absence of a firm replacement measure. The conservative Freedom Caucus has 40
members, which is enough to stop a vote if Democrats are also united in opposition. Last week, the Freedom Caucus also endorsed replacement legislation introduced by Sen. Rand Paul (R-Ky.) and caucus member Rep. Mark Sanford (R-S.C.). The Obamacare Replacement Act includes a continuous coverage provision for those with pre-existing conditions, provides a tax deduction for expanded use of health savings accounts (HSAs), and would allow the sale of insurance policies across state lines.

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