The Health 202: Biden’s pick to lead Medicare and Medicaid knows the policy weeds

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CMS administrator nominee Brooks-Lasure has extensive experience in key Medicaid issues.


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with Alexandra Ellerbeck

Chiquita Brooks-LaSure appears well on her way to becoming the next administrator of the Centers for Medicare and Medicaid Services, possibly before the month is out.


If confirmed by the Senate, she’ll be the agency’s first leader with specific expertise in all three of its biggest programs: Medicare, Medicaid and the Affordable Care Act.

“What is interesting about Chiquita’s career is she’s been at the most ground level of policy, helping to craft regulations that are very esoteric and fine-tuned — very technical aspects of Medicare and Medicaid policy,” said Nancy-Ann DeParle, who led CMS under former president Bill Clinton.

Republicans had virtually no criticisms of Brooks-LaSure at a Senate Finance Committee confirmation hearing yesterday.

A few hot-button topics, including Medicaid work requirements and abortion coverage in ACA marketplace plans, were alluded to. But no one questioned whether she was qualified to do the job.

UNITED STATES – April 15: Chiquita Brooks-LaSure testifies before the Senate Finance Committee during her nomination hearing to be administrator of the Centers for Medicare & Medicaid Services in Washington on Thursday, April 15, 2021. (Caroline Brehman/CQ Roll Call via AP Images)

  • During the Clinton administration, Brooks-LaSure analyzed Medicare and Medicaid spending at the White House Office of Management and Budget.
  • She worked on the House Ways and Means Committee from 2007 to 2010 as Democrats wrote the ACA.
  • Then she helped to implement the law, first at the Department of Health and Human Services and then at CMS.
That’s considerably more agency and legislative experience than previous CMS administrators had.
  • Seema Verma, who led the agency under former president Donald Trump, had never worked there before, instead spending the bulk of her career as a Medicaid consultant to states.
  • Of  former president Barack Obama’s administrators, Marilyn Tavenner was a nurse, hospital executive and then served as Virginia’s health secretary, while Don Berwick was a pediatrician and founder of a nonprofit institute aimed at improving health care.
  • George W. Bush’s CMS administrators included Mark McClellan, who had previously led the Food and Drug Administration and worked at the Treasury Department, and Tom Scully, who had worked at the Office of Management and Budget before leading the Federation of American Hospitals.
Those who know Brooks-LaSure emphasize her diplomatic style.

Melanie Nathanson, now a health-care lobbyist, first met Brooks-LaSure on Capitol Hill while working for then-Sen. Bob Graham (D-Fla.). Brooks-LaSure was more eager than most to hear diverse perspectives and find areas for common ground, Nathanson said.


“I think that is her natural place — to drive to consensus,” Nathanson told me.

DeParle described Brooks-LaSure as a problem-solver who is both collegial but firm when she feels strongly about something.

“It’s an iron fist and a silk glove,” DeParle said. “When she thinks the policy is wrong, she’s not going to hesitate to let you know it.”

During the hearing yesterday, Brooks-LaSure seemed to show that style when GOP senators expressed concerns over the Biden administration’s approach to the Medicaid program.

“I’m deeply concerned by the administration’s approach to Medicaid,” Sen. Mike Crapo (Idaho), the committee’s ranking Republican, said, referring to the new administration’s recent reversal of the Trump administration’s permission for states to impose work requirements.

“I will work to make sure states understand decisions and, as you said, are part of the decision-making,” Brooks-LaSure responded.

Crapo during a Senate Judiciary Committee hearing in 2020. (Demetrius Freeman/The Washington Post)

CMS will be a critical agency as Democrats seek to expand health coverage.

The White House and top congressional Democrats are currently considering which policy pathways to pursue to get coverage to around 29 million Americans who still lack it. 

Lowering the Medicare eligbility age is one possibility; another is making permanent more generous subsidies in the individual marketplaces. In either case, it would be up to CMS to oversee such changes.

The Senate Finance Committee may vote to advance Brooks-LaSure next week.

The panel is also considering the nomination of former Wisconsin health secretary Andrea Palm to serve as deputy HHS secretary.

A spokeswoman for Crapo responded “TBD” when asked whether the senator would vote to confirm Brooks-LaSure. Spokespeople for Sens. Bill Cassidy of Louisiana and Chuck Grassley of Iowa, two influential Republicans heavily involved in health policy, also declined to comment on how their bosses would vote.


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