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February 23, 2021

Our take: What you need to know about Biden's picks to lead CMS and CMMI

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    The Biden administration has announced President Biden plans to nominate Chiquita Brooks-LaSure as CMS administrator and name Liz Fowler as head of CMS' Center for Medicare and Medicaid Innovation (CMMI).

    4 key questions to watch in Biden's first 100 days

    Meet Chiquita Brooks-LaSure

    Brooks-LaSure started her career as a program examiner and lead Medicaid analyst for the federal Office of Management and Budget (OMB), and she currently serves as a managing director at Manatt Health, a professional services firm in New York.

    Brooks-LaSure previously worked as a Democratic staff member for the U.S. House Ways and Means Committee. During that time, Brooks-LaSure formed ties with California Attorney General Xavier Becerra, who at the time was a U.S. representative and currently is Biden's nominee for HHS secretary. Brooks-LaSure also worked alongside Sean McCluskie, who is now HHS' chief of staff, while McCluskie was serving as Becerra's chief of staff in Congress.

    In addition, Brooks-LaSure previously served as deputy director for policy at CMS' Center for Consumer Information and Insurance Oversight, as well as director of coverage policy at HHS, where she "played a key role in guiding the [Affordable Care Act (ACA)] through passage and implementation" under former President Barack Obama's administration, the White House said in a release.

    During the transition between former President Donald Trump's and Biden's administrations, Brooks-LaSure led Biden's HHS review team, assessing the operations for the department.

    Some of Brooks-LaSure's previous work and public comments provide insight on her stances on various health care policies. For instance, Brooks-LaSure has publicly shown support for state reinsurance programs and subsidies under the ACA, as well as for a variety of so-called "public option" health reform proposals, including creating an option that would allow more Americans to purchase Medicare plans.

    In a commentary published in Health Affairs, Brooks-LaSure and Fowler wrote that "coverage for the lowest-income Americans remains the most significant unfinished business of the ACA." Separately, Brooks-LaSure in a Manatt Health commentary published last year wrote that "the biggest coverage gap exposed (and exacerbated) by the Covid-19 crisis is that many U.S. residents are not enrolled in affordable, comprehensive health coverage that will cover Covid-19 testing and services and other health care costs."

    Brooks-LaSure also has advocated for the federal government to push more states into expanding their Medicaid programs under the ACA, including by implementing "a federal coverage guarantee" that "should include incentives, penalties, or both to prevent expansion states from rolling back existing Medicaid coverage," STAT News reports.

    In addition, Brooks-LaSure has spoken out about health disparities and inequities, especially relating to coverage issues for maternal health, Modern Healthcare reports. She also has raised concerns about the lack of available data regarding disparities in health care treatments and outcomes.

    Brooks-LaSure's nomination for CMS administration is subject to Senate approval. If confirmed by the Senate, Brooks-LaSure will be the first Black woman to lead CMS.

    Industry stakeholders applaud Brooks-LaSure's nomination

    Many stakeholders in the health care industry have applauded Brooks-LaSure's nomination for CMS administrator, MedPage Today reports.

    In a statement, Rick Pollack, president and CEO of the American Hospital Association (AHA), said AHA "applaud[s]" Brooks-LaSure's nomination. Pollack added that Brooks-LaSure's "previous experiences as a senior CMS and HHS official who helped implement the [ACA] 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."

    Chip Kahn, president and CEO of the Federation of American Hospitals, in a statement also praised the Brooks-LaSure's nomination, saying "there is no better person to lead CMS during this pivotal time." Brooks-LaSure is "uniquely qualified to step in and have an immediate impact," Kahn added.

    The Association of American Medical Colleges also praised Brooks-LaSure's nomination and touted her "detailed understanding of Medicare, Medicaid, and the ACA, as well as her commitment to health equity."

    And Emily Stewart, executive director of Community Catalyst, in a statement said the health advocacy group "applaud[s] President Biden for choosing a leader of CMS someone (who) understands what people need from our health care system, and what needs to change in order to make it more equitable for people across the country."

    Meet Liz Fowler

    The Biden administration also recently announced that Biden named Fowler as CMMI's new leader. The position does not require the Senate's approval.

    Fowler most recently served as EVP for programs with the Commonwealth Fund, and she previously served on the National Economic Council as a special assistant to Obama on health care and economic policy.

    Fowler also worked on ACA implementation efforts while serving in a role at HHS, and she held a role at Johnson & Johnson.

    In addition, Fowler previously served as chief health counsel for former Sen. Max Baucus (D-Mont.), who chaired the Senate Finance Committee and was key in drafting and passing the ACA, FierceHealthcare reports (Frieden, MedPage Today, 2/19; Diamond/Goldstein, Washington Post, 2/17; Florko/Facher, STAT News, 2/17; Cancryn et. al., Politico, 2/17; Brady, Modern Healthcare, 2/19; Alonso-Zaldivar, Associated Press, 2/17; Sullivan, The Hill, 2/19; King, FierceHealthcare, 2/19; Roubein, "Pulse," Politico, 2/19).


    Advisory Board's take

    What Biden's CMS, CMMI picks say about future policy priorities

    Heather BellBy Heather Bell, Senior Consultant

    A month into President Biden's term, we're beginning to see his health care leadership take shape—and with that we're getting early insights into the policies the Biden administration could prioritize.

    For example, Brooks-LaSure's background exploring state-level public option proposals complements Biden's own preference for expanding coverage via a public option over single-payer proposals touted by his Democratic presidential nominee challengers. This means that the Biden administration could look to use CMS to encourage states to adopt their own public options, if they cannot find enough votes in Congress to pass a national plan.

    As noted above, Brooks-LaSure also has shown support for increasing exchange subsidies and incentivizing the remaining 12 states to expand Medicaid—two proposals that are included in the House's Covid-19 relief package. If those proposals make it into the final bill, Brooks-LaSure would be tasked with overseeing implementation. Brooks-LaSure also aligns with Biden on improving health care equity and reducing maternal mortality disparities, opening up the possibility for policy movement on those issues. 

    One of the biggest questions we're watching is how the Biden administration will approach payment models. While Fowler's appointment as CMMI chief does not immediately answer that question, Fowler's past comments may shed some light on her priorities as the center reviews new and existing models. For instance, Fowler last year questioned whether the new Medicare Geographic Contracting model would adequately evaluate quality of care.

    But for now, we'll be watching Becerra's confirmation hearings for HHS Secretary this week, and will be eagerly awaiting hearing dates for Brooks-LaSure.

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