In an effort to appease Republican lawmakers and address recent concerns of bias, a panel that advises Congress on Medicaid policies has adopted a sweeping new conflict-of-interest policy.
Late last month, the Medicaid and CHIP Payment and Access Commission (MACPAC) voted unanimously to adopt a policy for disclosing financial and other interests as well as a process for members to recuse themselves from voting on recommendations in which they may have a conflict of interest. It also outlined activities that would be prohibited as long as an individual serves on the panel.
In recent months, Republican lawmakers have repeatedly questioned the usefulness of the advisory panel's recommendations because of a perceived bias. It's believed there are no GOP members on the panel, according to Hill sources. The last member to identify as Republican was Dr. David Sundwall, a former co-chair of MACPAC who left in 2014.
MACPAC members, who are paid a stipend, worked with a law firm to draft the polices that are meant to squash any perceived political motivations.
“There's the danger that a commissioner will be identified with the interests of a party and to such a degree that they really cannot be separated (from it) and there's the danger of political (bias) tainting the role of MACPAC,” Mark Borreliz, an attorney at the firm Verrill Dana, LLP, which helped draft policy, said last month at the MACPAC meeting.
The new policy states that members can not be involved in litigation relating to a federal healthcare program if either the House or the Senate is a party to the litigation.
That provision is likely a response to MACPAC Chairwoman Sara Rosenbaum signing an amicus brief supporting the Obama administration in House v. Burwell. The lawsuit, brought forth by the Republican-led House of Representatives, alleges that the administration violated the law by creating subsidies under the Affordable Care Act that were not appropriated by Congress.
“This policy has been developed in response to a request from Members of Congress that we have such a policy,” Rosenbaum said at the MACPAC meeting. “We think that the request was a reasonable one and one that is very appropriate for us to implement.”
Panel members will also be barred from “substantial political activity,” which includes being a paid employee or consultant of a political campaign, acting as a formal surrogate for a campaign or candidate, or engaging in sustained public involvement in forming policy positions on behalf of a campaign, office holder, or candidate.
Lawmaker response to the new policy has been mixed, said Anne Schwartz, MACPAC's executive director who circulated the document on Capitol Hill prior to its vote last month.
Staffers for Sen. Ron Wyden (D-Ore.) and N.J. Rep. Frank Pallone, also a Democrat, said the policies were sound, with Pallone staffers adding they felt MACPAC went above and beyond addressing the concerns of members, said Schwartz. Staffers for Sen. Orrin Hatch said the Utah Republican was also pleased.
House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) and Health Subcommittee Chairman Joe Pitts (R-Pa.) disagreed, stating the panel could have gone further.
A committee spokeswoman said Upton and Pitts felt the new policy took positive steps but needed more to enforce transparency.
Pundits offered mixed reactions.
“The highly politicized nature of Medicaid policy makes me cautious about relatively broad prohibitions,” said Joan Alker, a Medicaid policy expert at Georgetown University. “It's important to ensure that qualified experts are not prevented from serving on MACPAC”.
“MACPAC is only credible as long as it maintains its impartial and non-partisan status, and that is immediately compromised once commissioners begin acting independently in the service of a given politician or campaign,” said Tarren Bragdon, CEO of the Foundation for Government Accountability, a conservative think tank in Florida.
While Congress regularly adopts recommendations made by the Medicare Payment Advisory Commission, or MedPAC, which advises Congress on Medicare spending, it has adopted only half of the 13 recommendations made by MACPAC since its creation in 2009.
