Media Reports: White House Has Narrowed CMS Administrator Pick to Two Candidates
Media reports emerged on February 4 and 5 that indicate that the choice of which individual the Biden Administration will name as Administrator of the Centers for Medicare and Medicaid Services (CMS) has been narrowed to two individuals: Chiquita Brooks-LaSure and Mandy Cohen, M.D.
In a report published on Feb. 5, the Washington Post’s Paige Winfield Cunningham wrote that “The Biden administration has narrowed its search for Centers for Medicare and Medicaid Services administrator to two people – former Obama administration appointee Chiquita Brooks-LaSure and North Carolina Health Secretary Mandy Cohen, five people with connections to the administration tell me.”
Meanwhile, POLITICO’s Rachel Roubein, Susannah Luthi, and Adam Cancryn were more definitive in their reporting: writing on Feb. 4, they opened their article with the following statement: “Chiquita Brooks-LaSure, a longtime Democratic health policy expert, has emerged as the leading candidate to run President Joe Biden’s Medicare and Medicaid agency, according to three sources familiar with the Biden team’s discussions. The eventual head of the trillion-dollar agency will be charged with overseeing Biden’s pledge to expand Obamacare and reverse Trump-era restrictions on the health care safety net.”
Further, the POLITICO reporters wrote, “Biden's search for the next administrator of the Centers for Medicare and Medicaid Services has long revolved around two leading candidates: Brooks-LaSure and North Carolina health secretary Mandy Cohen, who both served in the agency during the Obama administration. But in recent weeks, Brooks-LaSure has been seen as the clear frontrunner, sources said. She is well-regarded by the Biden team and received high marks for helping lead the transition’s health care work. Though Cohen has support from a coalition of former Obama officials, including some now serving in the Biden administration, she is currently not considered the favorite for the job, two sources said.
As the Post’s Cunningham noted, “The eventual pick to lead the federal agency that oversees the government’s major health insurance programs will play a central role in reshaping how the government manages safety-net programs that provide tens of millions of Americans with health coverage, after some controversial and unprecedented reconfigurations by the previous administration. CMS is a trillion-dollar agency that oversees Medicare, Medicaid and the Affordable Care Act” (ACA).
“Both women worked at the sweeping agency during the Obama administration,” Cunningham noted. “Cohen, as chief operating officer and chief of staff, and Brooks-LaSure as deputy director in the office that oversees the ACA's insurance marketplaces and regulations. Brooks-LaSure is currently a managing director at consulting firm Manatt. In the years immediately after 2010 law was passed, Brooks-LaSure worked as director of coverage policy in the Office of Health Reform at the Department of Health and Human Services.” And she quoted “a person with close ties to the administration” as saying that “They would both be great, and they are both really well-liked.”
“She is very calm and very measured,” Dan Mendelson, whose firm Avalere Health employed Brooks-LaSure from 2003 to 2007, told Cunningham. “She doesn’t react too quickly and I think that kind of thoughtfulness will be really useful given the range of issues they have to deal with right now.”
What’s more, Cunningham noted, “There's another potential benefit to picking Brooks-LaSure: she has previously worked alongside California Attorney Xavier Becerra, who is Biden's nominee for HHS secretary. She served as a staffer on the House Ways and Means Committee while Becerra was a member of that committee. The well-documented acrimony between former HHS secretary Alex Azar and former CMS administrator Seema Verma under the Trump administration serves as a recent warning of the dysfunction that can occur when these two influential appointees don't work harmoniously.”
Brooks-LaSure currently works at the Manatt consulting firm, whose website describes it thus: “Manatt is a multidisciplinary, integrated national professional services firm known for quality and an extraordinary commitment to clients. We are keenly focused on specific industry sectors, providing legal and consulting capabilities at the very highest levels to achieve our clients’ business objectives. Our groundbreaking approach—bringing together legal services, advocacy and business strategy—differentiates us from our competitors and positions us to provide a unique and compelling value proposition. We strive to be essential to our clients. From our roots in banking, entertainment and government, we work with clients from industries as diverse as healthcare, financial services, media, technology, retail and consumer products, real estate, and energy.” Speaking of the firm’s healthcare practice, its website states that “We work with clients who are innovators and committed to change. If you are sitting at the intersection of complex issues that involve strategic, regulatory and legal opportunities, Manatt is the ideal partner to help you achieve your goals. We partner with a wide range of stakeholders, including state and federal policymakers and agencies; payers; healthcare providers and systems; foundations; associations; pharmaceutical, biotech and device companies; and product and service suppliers.”
With regard to Brooks-LaSure, who received her Master of Public Policy in 1999 from Georgetown University, Manatt’s profile of her states that “A former policy official who played a key role in guiding the Affordable Care Act (ACA) through passage and implementation, Chiquita Brooks-LaSure provides policy analysis and strategic advice to healthcare stakeholders across the private and public sectors. Her practice focuses on helping clients understand the implications of regulatory and legislative policies across private insurance, Medicaid and Medicare. Chiquita has more than 20 years of experience in health policy. As deputy director for policy at the Center for Consumer Information and Insurance Oversight within the Centers for Medicare & Medicaid Services, and earlier at the Department of Health & Human Services as director of coverage policy, she led the agency’s implementation of ACA coverage and insurance reform policy provisions.”
In addition, the Manatt profile states that, “Earlier in her career, Chiquita assisted House leaders in passing several healthcare laws, including the Medicare Improvements for Patients and Providers Act of 2008 and the ACA, as part of the Democratic staff for the U.S. House of Representatives’ Ways and Means Committee. She began her career as a program examiner and lead Medicaid analyst for the Office of Management and Budget, coordinating Medicaid policy development for the health financing branch. Her role included evaluating policy options and briefing White House and federal agency officials on policy recommendations with regard to the uninsured, Medicaid and the Children’s Health Insurance Program.”
The Wikipedia entry on Cohen notes that, “Since 2017, she has served as the Secretary of the North Carolina Department of Health and Human Services. Prior to serving as Health Secretary, Cohen was the Chief Operating Officer and Chief of Staff at the Centers for Medicare & Medicaid Services during the Obama Administration. She also served as the Deputy Director of Comprehensive Women's Health Services at the United States Department of Veterans Affairs and is a founding member and former Executive Director of Doctors for America.”
And it notes that “Cohen grew up on Long Island in the Baldwin hamlet in Hempstead, New York. Her mother worked as a nurse practitioner in emergency medicine, and inspired her to pursue a medical career. Cohen has a bachelor's degree in policy analysis and management from Cornell University. She received her medical degree from the Yale School of Medicine and has a graduate degree in public health from the Harvard T.H. Chan School of Public Health. She trained in internal medicine at Massachusetts General Hospital in Boston. In 2004, while a medical school student, she took up a position with the American College of Physicians on their National Council of Student Members. While in her residency, she served on Massachusetts General Hospital's committees for primary care, quality assurance, and recruitment. She later served as Co-Director for the Health Policy Elective at Massachusetts General Hospital and was a northeast representative for the American College of Physicians' National Council of Associates.”
POLITICO’s Roubein, Luthi, and Cancryn noted that “Health care advocates say there’s urgency for Biden to install a CMS administrator and fill out political appointments at the agency, even as the pandemic response dominates his immediate agenda. They worry further delay could mean months before the Senate approves his eventual nominee for CMS administrator, given the need to confirm other Cabinet posts.”
A public option angle?
Might the White House’s interest in Brooks-LaSure include her suggestions for a public option? Brooks-LaSure coauthored an article with Elizabeth Fowler of the Commonwealth Fund and Gay Mauser of Manatt, published in the March 2020 issue of Health Affairs, entitled “Building On The Gains Of The ACA: Federal Proposals To Improve Coverage And Affordability,” in which the authors wrote that a number of policy options exist for building on the strengths of the ACA, including “extend[ing] comprehensive coverage to all low-income Americans and increase[ing] coverage affordability for middle-income Americans.” The Medicaid program, they wrote, could also be built out by “expand[ing] eligibility for Medicaid in the early years of the ACA to states that have not yet expanded Medicaid and increasing Marketplace cost-sharing subsidies.” The authors also addressed the potential inherent in creating a public option. “A public option could also be implemented at the federal level, leveraging the administrative savings and bargaining power of Medicare as proposed in the Affordable Health Care for America Act, an earlier version of the ACA that was passed by the House of Representatives in 2009. In 2013 the Congressional Budget Office estimated that a public plan would reduce the deficit by $158 billion over ten years.24 A public option could be deployed everywhere or limited to certain geographic regions—such as markets with high premiums, areas with only one or two Marketplace plans, or states that have not expanded Medicaid.”
The article's authors wrote further that, “Depending on how it was structured, a federally administered public option could result in lower federal spending, cost sharing, and provider reimbursement rates. Setting provider rates by either pegging them to a percentage of Medicare rates or negotiating rates directly would require striking a balance among health care stakeholders—as well as the political capital to overcome significant opposition.” The authors added that “The ten-year anniversary of the ACA presents an opportunity to reflect on the law’s success and identify areas for improvement. The continued desire of policy makers and the public to cover the uninsured and address affordability is encouraging. Intermediate policy options that build on the ACA could make a difference in the lives of millions of Americans and set the stage for future reforms.”
