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 Verma Tells Senators She Wants Changes To Medicaid Program

Without tipping her hand, Seema Verma, President Trump’s choice to run the Centers for Medicare & Medicaid Services (CMS), on Feb. 16 told members of the Senate Finance Committee that if confirmed she would work to enact an overhaul of the Medicaid program. She did not, however, say if this meant she favors the Republican-backed plan to block grant or set per capita caps on federal funding for the federal-state program.

Verma avoided too many direct answers, sticking to a general theme that she would work “on the front end” with providers and others stakeholders on a range of issues like MACRA (Medicare Access and CHIP Reauthorization Act) implementation for example.
On Medicaid, Sens. Bob Menendez (D-N.J.) and Maria Cantwell (D-Wash.) pressed her hardest on the questions of what she would like seen done to change the program that so many low-income seniors living in skilled nursing care centers rely on.
When asked by Menendez about how CMS would provide health care to those most in need, Verma drew distinctions about the program’s recipients. “When I think about the Medicaid program, I think of it in almost two parts,” she said. “There is the part that serves the aged and the blind and the disabled. That is a very different population than [providing aid for] some of the abled-bodied individuals [many made eligible under the Affordable Care Act]. But at the end of the day, all Americans should have access to high-quality affordable health care coverage.”
In a follow-up question, Cantwell asked if Verma backed block grants or per capita caps, which President Trump supports, along with congressional leaders like House Speaker Paul Ryan (R-Wis.).
Without saying yes or no, Verma made clear change is in store for Medicaid. “The status quo is not acceptable, we can do a lot better,” she said, pointing to below-par health outcomes for Medicaid recipients and lack of access to care as major reasons, with nearly one-third of doctors refusing to accept patients from the program.
“We need to think about how to make this program work better,” which may include block grants or caps, Verma said.
Switching issues, Sen. Sherrod Brown (D-Ohio) asked Verma about observation stays, a priority issue for skilled nursing care providers that believe Medicare beneficiaries’ access to care is being constrained by the increased use of extended hospital stays in observation status.
Verma said she “would work with providers on this,” without getting into details. Brown, along with a bipartisan grouping of Sens. Susan Collins (R-Maine), Bill Nelson (D-Fla.), and Shelley Moore Capito (R-W.Va.), along with Reps. Joe Courtney (D-Conn.) and Joe Heck (R-Nev.), have introduced legislation (S 843/HR 1571) to address the situation.
Verma testified during another week of strategizing by the Trump administration and Republican leaders in Congress on the battle plan for repealing and replacing the Accountable Care Act (ACA). House Republicans met on Feb. 16 to review their plan, which includes an expansion of health savings accounts, funding for high-risk pools to care for the sick, and the aforementioned major revamp of Medicaid.
But, even with plans being circulated, industry sources say there is no clear path yet on repeal and replace, with thorny issues still to be worked out, like what to do about Medicaid expansion lives under the ACA, how to support the ACA individual markets, and whether taxes under the ACA would be scrapped, like those assessed on health insurers.
Regardless, as Congress heads out on a 10-day Presidents’ Day break starting Feb. 18, Ryan said House Republicans would introduce legislation after the break. Trump, during his 77-minute press conference on Feb. 16, also said a replacement plan was in its final stages.
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