Chiquita Brooks-LaSure is President Joe Biden's pick to lead CMS. Colleagues describe the long-time Beltway insider as a consummate professional and point to her experience and track record in Washington.
"America's hospitals and health systems applaud the nomination of Chiquita Brooks-LaSure to serve as the next administrator of the Centers for Medicare & Medicaid Services, the American Hospital Association said in a statement. "Her previous experiences as a senior CMS and HHS official who helped implement the Affordable Care Act and her work on the House Ways and Means Committee gives her a deep understanding of the importance of healthcare coverage and protections for consumers."
In addition to her work on the Affordable Care Act during her time on the House Ways and Means Committee, Brooks-LaSure has worked on Medicare, Medicaid and commercial insurance at the White House budget office and CMS. She's also advised providers, insurers, life sciences companies and states on a wide range of healthcare issues. Most recently, she led the HHS agency review team during the Biden-Harris transition.
Her former boss, Clinton administration official and Avalere Health founder Dan Mendelson, called her a "team player," saying that she would carry out Biden's healthcare agenda rather than push specific issues of interest if she's confirmed.
Ruth Tabak, director at consulting firm Berkeley Research Group, overlapped with Brooks-LaSure during her earlier stays on Capitol Hill and CMS. She expects her former coworker to run an orderly agency that's committed to developing and implementing effective, durable policies with considerable input from providers, payers and other stakeholders. The future CMS leader knows the agency must get buy-in from providers and insurers since they'll play critical roles in putting CMS policies into practice, Tabak said. She doesn't expect too many of the agency's policies to get tied up in court because Brooks-LaSure would likely take a measured approach to rulemaking.
Here's what we know about the nominated CMS administrator on four key issues.
Coverage expansion and affordability
Brooks-LaSure championed the ACA's role in boosting coverage in a Health Affairs article last year but said, "coverage for the lowest-income Americans remains the most significant unfinished business of the ACA." She and her coauthors, including rumored pick as CMS Center for Medicare and Medicaid Innovation head Liz Fowler, outlined several policy options to address the coverage gap, including increased federal funding for states to expand Medicaid and boosting the number of people that qualify for marketplace subsidies.
Congressional Democrats and the White House hope to encourage holdout states to expand their Medicaid programs by increasing the federal contribution for their traditional Medicaid population by 5% over two years.
The nominated CMS administrator also supported a Medicare buy-in during congressional testimony and advised states on Medicaid buy-in options. She appears to be open to a wide range of public option proposals. Brooks-LaSure also supports state reinsurance programs and subsidies. She would oversee state's applications for Section 1332 waivers as CMS administrator. Nearly all approved waivers have been for reinsurance programs.
Cybele Bjorklund, vice president for federal strategy at Johns Hopkins University and Johns Hopkins Medicine, said Brooks-LaSure has a comprehensive view of how Medicare, Medicaid and the exchanges work together to provide coverage under the ACA. She expects her to focus on ways to improve coverage for populations that are likely to churn or have special needs like dual-eligibles.
Brooks-LaSure has testified and written about disparities and equity in healthcare on several occasions, often focusing on coverage issues related to maternal health. She's also expressed concern about care inequities among people with health coverage and the lack of available data on disparities in treatment and outcomes. According to law firm Akin Gump Strauss Hauer & Feld, equity could be a top CMS priority, as the agency could move to collect data more data from providers and payers. It could also make policy changes to promote equity.
Tabak said that while Brooks-LaSure has always been deeply concerned about healthcare disparities, federal policymakers and key players in the healthcare industry might be more willing to take action in the wake of COVID-19 and George Floyd's death. Equity concerns have never gotten top billing from CMS.
CMS will have to move quickly to put the No Surprises Act into practice, as most of the legislation takes effect on Jan. 1. Brooks-LaSure will oversee the creation of an independent dispute resolution process and other related regulations and guidance. Akin Gump Strauss Hauer & Feld predicts that Brooks-LaSure will "afford a level playing field for both providers and insurers in implementing a ban on surprise billing," based on her connection with FAIR Health, a nonprofit working to increase healthcare cost transparency. Tabak lent some credence to that prediction, saying that Brooks-LaSure respected providers and payers alike.
CMMI would likely play a key role during Brooks-LaSure's leadership because Congress is unlikely to pass significant healthcare legislation in the next few years. There's a lot of competition to control the agency's agenda because it allows policymakers to test new ways to pay for and deliver healthcare. Experts said Brooks-LaSure would probably use CMMI to move the ball forward on leading administration priorities like lowering drug prices and improving health equity.
While CMMI has mainly focused on testing payment reforms within the Medicare program, Brooks-LaSure could use the agency to support more payment reforms in Medicaid and throughout the broader healthcare system, said former CMS Administrator and FDA Commissioner Dr. Mark McClellan. Payment models that address the social determinants of health and health equity could get special attention.