The Health 202: Biden narrows picks to lead Medicare and Medicaid down to two choices

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A Manatt consultant and former Bacerra associate is being heralded as the next head of CMS.


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with Alexandra Ellerbeck

The Biden administration has narrowed its search for Centers for Medicare and Medicaid Services administrator to two people – former Obama administration appointee Chiquita Brooks-LaSure and North Carolina Health Secretary Mandy Cohen, five people with connections to the administration tell me. 


The eventual pick to lead the federal agency that oversees the government’s major health insurance programs will play a central role in reshaping how the government manages safety-net programs that provide tens of millions of Americans with health coverage, after some controversial and unprecedented reconfigurations by the previous administration. CMS is a trillion-dollar agency that oversees Medicare, Medicaid and the Affordable Care Act. 


Cohen, as chief operating officer and chief of staff, and Brooks-LaSure as deputy director in the office that oversees the ACA’s insurance marketplaces and regulations. Brooks-LaSure is currently a managing director at consulting firm Manatt. In the years immediately after 2010 law was passed, Brooks-LaSure worked as director of coverage policy in the Office of Health Reform at the Department of Health and Human Services.

“They would both be great, and they are both really well-liked,” said a person with close ties to the administration who spoke on the condition of anonymity to discuss the personnel matter.

Brooks-LaSure is now favored for the spot, three of the sources said. 

She was more involved in Biden’s campaign and headed up his HHS transition team. That could put her in a better spot to immediately start working with civil servants within CMS.

“She is very calm and very measured,” said Dan Mendelson, whose firm Avalere Health employed Brooks-LaSure from 2003 to 2007. “She doesn’t react too quickly and I think that kind of thoughtfulness will be really useful given the range of issues they have to deal with right now.”

There’s another potential benefit to picking Brooks-LaSure: she has previously worked alongside California Attorney Xavier Becerra, who is Biden’s nominee for HHS secretary. She served as a staffer on the House Ways and Means Committee while Becerra was a member of that committee.

The well-documented acrimony between former HHS secretary Alex Azar and former CMS administrator Seema Verma under the Trump administration serves as a recent warning of the dysfunction that can occur when these two influential appointees don’t work harmoniously.

The White House declined to comment on the status of the CMS nomination. Neither Brooks-LaSure nor Cohen responded to emailed questions.

The next CMS director will have a lot on their plate.

Top on the agenda will be unraveling changes the Trump administration made to the Obamacare marketplaces and the Medicaid program. 

As we’ve reported, the new administration is likely to crack down on short-term plans that can offer skimpy benefits and tighten up rules around the insurance products that are sold on and the state-run exchanges. Officials will also be looking at ways to walk back what amount to permission slips the previous administration gave states to enact new requirements for Medicaid enrollment.

At the same time, the part of Medicare that covers hospital costs for seniors is running dangerously short on funds. It’s projected to become insolvent by 2024, two years earlier than expected. That’s closest to insolvency Medicare has been since 1971, when its trustees projected a two-year insolvency window.

But picking a CMS leader isn’t the administration’s top priority at the moment.

Becerra is still awaiting Senate confirmation, a process which has been delayed as Senate leaders fought over how to divide party control of the 50-50 Senate.

Confirmation hearings for Becerra aren’t expected to start until the week of Feb. 15 and could be pushed even later. 

And the CMS position isn’t the only top health-care slot Biden has yet to fill. He hasn’t yet named a nominee to lead the Food and Drug Administration, or nominees for more than a dozen other key posts at HHS.

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