The health program consultant who may be the next head of the Centers for Medicare & Medicaid Services says the best medicine for U.S. health care system problems is patient choice.
Seema Verma, Trump's nominee for the CMS administrator post, talked often about the importance of putting the patient in the driver's seat today at a nomination hearing organized by the Senate Finance Committee.
CMS, an arm of the U.S. Department of Health and Human Services, oversees Medicare, Medicaid and Affordable Care Act programs, such as the ACA exchange system, the ACA rate review program, and the ACA minimum medical loss ratio requirements.
As the head of Medicare and Medicaid, she would help regulate long-term care programs that pay about 60 percent of U.S. nursing home bills and 20 percent of home health care bills.
Verma avoided providing direct, detailed answers to many of the senators' questions regarding specific concerns about Medicare, Medicaid or the Affordable Care Act. She instead said one of her principles is that patients and their doctors should be the ones making decisions about care, not the federal government.
"We need to ensure that people have choices about their care," Verma said, according to a video of the hearing that streamed on the Senate Finance Committee website. "We shouldn't assume that all vulnerable or low-income populations don't want choices, or aren't capable of making the best decisions for themselves and their families."
Verma, the owner of Indianapolis-based SVC Inc., is best known for her successful effort to build a system similar to a health reimbursement arrangement into the Indiana Medicaid program. Her company has also helped build HRA-like accounts into other states' Medicaid programs, and it provided training programs for Indiana's Affordable Care Act public exchange system navigators.
Verma has faced less criticism than many other Trump administration cabinet nominees, and the tone of the hearing was generally cordial.
Sen. Orrin Hatch received a clear answer about Medicare Advantage, and a fuzzier answer about long-term care programs. (Photo: Senate Finance)
Sen. Ron Wyden, D-Ore., expressed concern about the fact that SVC received payments from some vendors, such as Milliman Inc., an actuarial firm, while it was involved in managing their work for Indiana's Medicaid program. But Wyden acknowledged that SVC's activities complied with Indiana state conflict-of-interest rules. Verma said that her firm had disclosed its business relationships and tried to arrange its activities to avoid potential conflicts of interest.
Democrats on the committee also questioned whether Verma was giving them enough information about her views on important health policy issues.
Senate Finance Chairman Orrin Hatch, R-Utah, asked Verma whether she could promise that she would work to preserve and strengthen the Medicare Advantage program.
Verma gave a clear, straightforward answer to that question. "I can," she said. "It would be a pleasure for me to work with you on that."
But, when Hatch asked Verma earlier about her views on the future of federal long-term care programs, given the changing demographics of the American people, Verma gave a general answer about the need to make Medicaid more flexible and reduce the amount of paperwork states have to do to improve their Medicaid programs.
Verma gave a careful answer about how she would handle Affordable Care Act-related issues, including the arm of CMS that handles ACA issues, the Center for Consumer Information and Insurance Oversight.
"If I am confirmed as administrator, my job is to implement the law," Verma said.
Verma also explained that the way she would handle CCIIO would depend on what Congress does about the ACA.
CMS officials are seeking comments on proposed ACA exchange regulations that are set to appear in the Federal Register Friday, and appeared in a preview form on the CMS website Wednesday. Verma said she did not participate in the drafting of the proposed regulations, because she is not yet part of CMS, and had not yet read the draft.
Sen. Robert Menendez, D-N.J., asked about a specific ACA issue: What Verma thinks about including coverage for therapy with people with autism in the ACA essential health benefits package. The EHB package is a standard package of benefits that all individual and small-group major medical plans sold after Jan. 1, 2014, are supposed to cover.
Verma told Menendez that the federal Office of Government Ethics has told her not to weigh in on mental health policy issues, because her husband, Dr. Sanjay Mishra, is a child psychiatrist.
Mishra is a partner at Carmel, Indiana-based Indiana Health Group. The practice says on its website that it's one of the biggest behavioral health providers in Indiana and now has provider network agreements with units of Anthem Inc., Cigna Corp., Aetna and a number of other carriers.
At one point, Sen. Pat Roberts, R-Kan., made a slip that might indicate how overwhelming trying to keep tabs on CMS is for many lawmakers. He was the senator who asked Verma about CCIIO, an agency which has had the same name and been known by the same acronym since 2011. Roberts started the question by telling her, "There is CMS's Center for Consumer Information and Insurance Oversight. Sih-sigh-oh. That's the new acronym. I was not aware of that. I thought I knew most of them."
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