Chiquita Brooks-LaSure, whom President Joe Biden nominated to be Administrator of the federal Centers for Medicare and Medicaid Services (CMS), was confirmed by the U.S. Senate by a vote of 55 to 44, after a delay of more than three months. President Biden nominated Brooks-LaSure back on February 17, but her confirmation had been delayed by two main issues. That delay of 96 days was nearly unprecedented for a nomination at that level. Five Republicans joined Senate Democrats to confirm her.
The first issue had been Senate Republicans’ opposition to the nomination of Xavier Becerra to be Secretary of Health and Human Services. Becerra, who had served for as Attorney General of California from January 2017 through March 2021, had been nominated by Biden to be HHS Secretary back on December 7, when Biden was still President-elect, but Republican opposition to Becerra, based on his having been the lead state attorney general to defend the Affordable Care Act (ACA) before the Supreme Court, made his confirmation difficult, and he was not confirmed until March 19.
The other issue slowing the confirmation of Brooks-LaSure, who had been working as a senior consultant at the Los Angeles-based Manatt Health, had nothing to do with her as an individual; instead, some Senate Republicans stated explicitly that they would refuse to support her confirmation as long as the state of Texas had not received a waiver that former CMS Administrator Seema Verma had promised that state, as its leaders wanted to make major changes to their Medicaid program without agreeing to ACA-based Medicaid expansion, a requirement under that law.
As The Hill’s Peter Sullivan wrote in an April 20 report, “Sen. John Cornyn (R-Texas) is placing a hold on President Biden’s nominee to oversee Medicaid, an apparent sign of the anger from Republicans over the withdrawal of Texas’s Medicaid waiver last week. Cornyn’s office said Tuesday that he would put up a procedural roadblock to the nomination of Chiquita Brooks-LaSure to be administrator of the Centers for Medicare and Medicaid Services (CMS). He accused the Biden administration of playing ‘political chicken’ by rescinding federal funds for Texas in a bid to pressure the state to expand Medicaid under the Affordable Care Act (ACA).” The report quoted a Cornyn spokesperson as stating that “Senator Cornyn placed the hold after the Biden Administration decided to play political chicken with uninsured Texans’ healthcare. He’s requested additional information from the nominee and the Administration about how they plan to ensure our most vulnerable Texans don’t lose their healthcare because of their actions.” As Sullivan wrote on April 20, “The Biden administration moved last week to rescind a Medicaid waiver given to Texas in the final days of the Trump administration. That waiver extended federal funds that reimburse hospitals for providing care for uninsured people. Advocates of Medicaid expansion have long argued it would make much more sense to give people health insurance in the first place, through Medicaid.”
As the New York Times’s Noah Weiland and Margot Sanger-Katz wrote on Tuesday, “Her nomination was challenged by Senator John Cornyn, Republican of Texas, who opposed a recent Medicaid policy decision affecting his home state. Biden administration Medicaid officials withdrew the approval of a waiver that would have given hospitals more than $100 billion in federal dollars over a decade for treating patients without insurance. The officials said the waiver’s approval, which was granted in the closing days of the Trump administration, had been rushed. The agency has also begun rolling back state Medicaid work requirements approved in some states during the Trump administration.” Weiland and Sanger-Katz also noted that “Ms. Brooks-LaSure’s predecessor, Seema Verma, feuded bitterly during the Trump administration with the H.H.S. secretary, Alex M. Azar II, and she attracted inspector general and congressional investigations into her agency’s lavish spending on outside consultants who worked to polish her personal brand.”
Brooks-LaSure had worked inside the department of Health and Human Services (HHS) previously, serving as deputy director for policy at the Center for Consumer Information and Insurance Oversight within the agency, and earlier at HHS as director of coverage policy, where she helped to lead the implementation of the ACA.
In their Feb. 17 report on Brooks-LaSure’s nomination, POLITICO’s Adam Cancryn, Susannah Luthi, and Rachel Roubein wrote that “Brooks-LaSure, who consults with states at Manatt Health, during the Obama administration was deputy director at a top CMS office overseeing the health insurance markets. She had previously helped enforce Obamacare insurance reforms at HHS. Prior to her stint in the Obama administration, she worked on parts of Obamacare during the law's drafting as a health staffer on the House Ways and Means Committee. It was there she forged working ties with then-Rep. Xavier Becerra, Biden's nominee to run the health department that houses CMS,” they wrote, referring to the Senate Health, Education, Labor and Pensions Committee And its Finance Committee.
“Well-regarded in Washington policy circles,” they added, “Brooks-LaSure was an early favorite for the CMS post. She was chosen to co-lead Biden’s HHS agency review team during the transition. Becerra's nomination in early December seemed to boost Brooks-LaSure’s chances to helm CMS, given their past working relationship on Capitol Hill. One former colleague described Becerra as one of the ‘go-to’ lawmakers that Brooks-LaSure worked with on health care issues.
In another report published on Feb. 17, CNN’s Arlette Saenz and Tami Luhby wrote that Brooks-LaSure “was a top official at the agency during the Obama administration and worked to implement the 2010 Affordable Care Act. Prior to joining the Obama administration, she was part of the Democratic staff for the House Ways and Means Committee, where she also worked on the landmark health reform law. Currently a managing director at Manatt Health, a professional services firm, Brooks-LaSure also served as a co-lead of the Department of Health and Human Services agency review team during the Biden-Harris transition period,” they wrote.
Further, Saenz and Luhby wrote in February, “Brooks-LaSure would be a key player in executing Biden's promises to rebuild the Affordable Care Act and strengthen Medicaid -- as well as institute a government-run public option and lower Medicare's eligibility age to 60, from 65. The $1 trillion agency, the largest within HHS, oversees much of Obamacare and the federal exchange, Healthcare.gov. In total, more than 145 million Americans receive their health coverage through programs the agency administers, including Medicare, Medicaid, the Children's Health Insurance Program (CHIP) and the Affordable Care Act. In recent years, Brooks-LaSure has co-authored reports on expanding coverage through state Medicaid buy-in proposals and on advancing health equity. Last month, she and her colleagues at Manatt published a report on two potential public option models in Nevada,” they added.
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.”
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. 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 authors wrote 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.”
Brooks LaSure received her A.B. in politics from Princeton University in 1996 and her master of public policy from Georgetown University in 1999.