WASHINGTON — The Senate voted 55-44 Tuesday to confirm Chiquita Brooks-LaSure as administrator of the Centers for Medicare & Medicaid Services (CMS).
Nominations for a position like CMS administrator are not usually controversial, but these are unusual times. Sen. John Cornyn (R-Texas) explained on the Senate floor Monday that he would vote against Brooks-LaSure not because she wasn’t qualified, but because “the Biden administration has taken the unprecedented step of rescinding an agreement with my state and the previous administration to maintain the stability of our state’s Medicaid program.”
Cornyn acknowledged that Brooks-LaSure, who will be the first Black woman to head the agency, had nothing to do with the Texas waiver rescission, “but before her nomination could advance, members of the Senate deserve a commitment from the administration that it won’t try to force the hand of other states, including Texas, by putting the healthcare of millions of vulnerable citizens on the line. If we don’t stand up now and push back on this reckless move, who will be next?”
Sen. Ron Wyden (D-Ore.) disagreed. Regarding the Texas waiver, “first, nothing is going to change for health providers and patients in Texas for more than a year as a result of this decision,” he said. “That means there’s plenty of time to work out a solution that doesn’t get rushed and follows the right process with public comment.” He added that Brooks-LaSure “made clear in her Finance Committee hearing that she’s committed to working on a bipartisan basis with state officials on this issue as well.”
“Ms. Brooks-LaSure brings decades of health policy experience to CMS, and I think it would be fair to say she has worked on healthcare from just about every angle short of scrubbing into the operating room herself,” Wyden said. “The American people need a chief of Medicare and Medicaid as soon as possible. Blocking this nomination slows down important work that needs to be done.”
The final vote was mostly along party lines, with five Republicans — Roy Blunt (R-Mo.), Richard Burr (R-N.C.), Susan Collins (R-Maine), Jerry Moran (R-Kan.), and Lisa Murkowski (R-Alaska) — crossing over to vote for President Biden’s nominee.
The 10-year Texas waiver extension would have provided the state with $11.7 billion annually through 2030 and helped to fund the state’s uncompensated care pool. The CMS decision to rescind the waiver came in the form of a letter to Stephanie Stephens, the state’s Medicaid director, from CMS acting administrator Elizabeth Richter. Richter noted that in its application for a waiver extension, the state sought to be exempt from the usual requirement of a notice and comment period.
“Texas asserted that this exemption was necessary to provide financial stability for providers in the state, as well as the state’s Medicaid program, in the midst of the COVID-19 public health emergency,” Richter wrote.
However, “the state did not articulate a sufficient basis for us to conclude that approving the state’s emergency request for an exemption from the normal public notice process was needed to address the COVID-19 public health emergency or other sudden emergency threat to human lives,” she continued. “Instead, Texas’s request for an extension of the [waiver] and the amendments we initially approved alongside the extension were ordinary programmatic actions that could have proceeded, and still may proceed, through the ordinary programmatic processes,” including a period for public notice and comment.
The rescission means that absent any further action, Texas’s 1115 waiver will end on Sept. 30, 2022.
Healthcare groups praised the confirmation. “The Surgical Care Coalition congratulates Chiquita Brooks-LaSure for her successful confirmation as CMS Administrator,” David Hoyt, MD, executive director of the American College of Surgeons, said in a statement. “With decades of experience on the frontlines of health policy, Ms. Brooks-LaSure is a tireless advocate for improving health equity and access to quality care. Surgeons across the country look forward to working with CMS leadership and the entire Biden-Harris administration on advocating for patients and improving access to high-quality surgical care.”
“We look forward to working with Chiquita Brooks-LaSure as American healthcare emerges from the COVID crisis,” Chip Kahn, president and CEO of the Federation of American Hospitals, a trade group of for-profit hospitals, said in a statement. “With over two decades experience in health policy, including roles at CMS, HHS [Health and Human Services], and on Capitol Hill, Ms. Brooks-LaSure is uniquely qualified to step into the position of administrator and have an immediate and positive impact … While the fight against COVID is not over, as the pandemic winds down we need to move forward on the broader health care agenda and I am confident our new Administrator is exceptionally equipped to provide the leadership that is crucial for CMS at this time and beyond.”
“Ms. Brooks-LaSure is passionately committed to improving health equity in our nation’s healthcare system and has worked tirelessly to expand coverage to uninsured Americans by building on what we have through the Affordable Care Act (ACA),” Matt Eyles, president and CEO of America’s Health Insurance Plans, a trade group for health insurers, said in a statement. “We look forward to working with Administrator Brooks-LaSure to strengthen and improve Medicare, Medicaid, and ACA marketplace coverage for the millions of seniors, children, veterans, disabled, low-income adults, and other Americans these vital programs serve.”