Top Senate Republican holds up CMS nominee over Medicaid waiver

MM Curator summary


Cornyn is holding of Lasure nomination over CMS un-approving the TX DSRIP waiver.


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WASHINGTON — A top Senate Republican is holding up the confirmation of President Biden’s nominee to lead Medicare and Medicaid, he told STAT.

In a brief interview, Sen. John Cornyn (Texas) said he had placed a hold on the confirmation of Chiquita Brooks-LaSure, the pending administrator of the Centers for Medicare and Medicaid Services, using a phrase that refers to a senators’ ability to temporarily block a nomination from advancing to a vote. His opposition, he said, stems from the Biden administration’s recent rejection of Texas’ request to extend its Medicaid waiver, which the Trump administration had previously approved.

I met with her one day about the 1115 waiver, and said how important it was to my state,” Cornyn told STAT in an interview, referring to the Trump-approved funding agreement, which helped to reimburse the state’s hospitals for care given to uninsured patients. “Then the next day, the Biden administration rescinded it, and it’s completely in bad faith and irresponsible.”


In practice, Senate Majority Leader Chuck Schumer (D-N.Y.) can decide how long to honor Cornyn’s hold. It’s unlikely he’d allow Cornyn’s objection to derail the confirmation of a key Biden nominee who is otherwise well-liked among Democrats. Schumer’s office did not immediately respond to a request for comment.

Still, Cornyn’s move underscores his anger, and that of many Texas Republicans, over the White House’s decision.


The Biden administration told Texas officials on April 15 that it was rejecting their $100 billion request to extend most of its existing Medicaid arrangement for the next decade. In rejecting the waiver, the acting CMS administrator ruled that the Trump administration had not gone through the full federal rulemaking process when it approved the request on Jan. 15, less than a week before Biden took office.

An HHS spokesperson said that Texas’ current waiver lasts through September 2022, which gives state officials enough time to go through the full public comment process. CMS will work with Texas on its waiver resubmission, the spokesperson said.

The move, however, is also seen as an attempt to pressure Texas into expanding its Medicaid program to provide health insurance to more low-income residents.

Currently, Texas is one of 12 states that has not accepted federal dollars for an expansion of Medicaid eligibility since the Affordable Care Act’s passage in 2010. Roughly 5 million Texans, or 18.4% of the population, don’t have health insurance, giving it the highest percentage of uninsured residents among the 50 states.

Congress offered holdout states an extra financial incentive to expand Medicaid in its latest Covid-19 relief package, but that offer doesn’t appear to have swayed Texas officials.

Under the existing arrangement, the federal government allows Texas to use Medicaid funds in ways that are typically not permitted, like reimbursing hospitals for care provided to patients without health insurance.

Progressives have cast Texas’ strategy as a poor substitute for using Medicaid expansion to insure low-income residents and investing in primary care, as opposed to stepping in to cover costs for uninsured patients who wind up needing emergency treatment.

Conservatives, however, have lambasted the Biden administration for jeopardizing care for the state’s most vulnerable.

“I’m going to hold her nomination until we can sort something out,” Cornyn said. “This is our basic safety net for healthcare in Texas, and for the administration to pull the rug out from under us like that is just unacceptable.”

Major health industry groups there, including the Texas Medical Association and Texas Hospital Association, have also objected vocally. The hospital lobby said it was “extremely disappointed” by the Biden administration’s decision, and claimed the move undermined the social safety net during a pandemic.

It’s not immediately clear what impact Cornyn’s hold will have. A Democratic spokesman for the Senate Finance Committee said the panel was likely to vote on her nomination this week. Assuming she prevails in committee, Sen. Majority Leader Chuck Schumer (D-N.Y.), could face delays bringing her nomination to a floor vote in light of Cornyn’s objection. Ultimately, though, nominees only need a simple majority of the Senate to vote for confirmation.


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