[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
SABOTAGE: THE TRUMP ADMINISTRATION'S ATTACK ON HEALTHCARE
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
OCTOBER 23, 2019
__________
Serial No. 116-71
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Energy and Commerce
govinfo.gov/committee/house-energy
energycommerce.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
43-607 PDF WASHINGTON : 2021
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COMMITTEE ON ENERGY AND COMMERCE
FRANK PALLONE, Jr., New Jersey
Chairman
BOBBY L. RUSH, Illinois GREG WALDEN, Oregon
ANNA G. ESHOO, California Ranking Member
ELIOT L. ENGEL, New York FRED UPTON, Michigan
DIANA DeGETTE, Colorado JOHN SHIMKUS, Illinois
MIKE DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California CATHY McMORRIS RODGERS, Washington
KATHY CASTOR, Florida BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland PETE OLSON, Texas
JERRY McNERNEY, California DAVID B. McKINLEY, West Virginia
PETER WELCH, Vermont ADAM KINZINGER, Illinois
BEN RAY LUJAN, New Mexico H. MORGAN GRIFFITH, Virginia
PAUL TONKO, New York GUS M. BILIRAKIS, Florida
YVETTE D. CLARKE, New York, Vice BILL JOHNSON, Ohio
Chair BILLY LONG, Missouri
DAVID LOEBSACK, Iowa LARRY BUCSHON, Indiana
KURT SCHRADER, Oregon BILL FLORES, Texas
JOSEPH P. KENNEDY III, SUSAN W. BROOKS, Indiana
Massachusetts MARKWAYNE MULLIN, Oklahoma
TONY CARDENAS, California RICHARD HUDSON, North Carolina
RAUL RUIZ, California TIM WALBERG, Michigan
SCOTT H. PETERS, California EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan JEFF DUNCAN, South Carolina
MARC A. VEASEY, Texas GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
A. DONALD McEACHIN, Virginia
LISA BLUNT ROCHESTER, Delaware
DARREN SOTO, Florida
TOM O'HALLERAN, Arizona
------
Professional Staff
JEFFREY C. CARROLL, Staff Director
TIFFANY GUARASCIO, Deputy Staff Director
MIKE BLOOMQUIST, Minority Staff Director
Subcommittee on Oversight and Investigations
DIANA DeGETTE, Colorado
Chair
JAN SCHAKOWSKY, Illinois BRETT GUTHRIE, Kentucky
JOSEPH P. KENNEDY III, Ranking Member
Massachusetts, Vice Chair MICHAEL C. BURGESS, Texas
RAUL RUIZ, California DAVID B. McKINLEY, West Virginia
ANN M. KUSTER, New Hampshire H. MORGAN GRIFFITH, Virginia
KATHY CASTOR, Florida SUSAN W. BROOKS, Indiana
JOHN P. SARBANES, Maryland MARKWAYNE MULLIN, Oklahoma
PAUL TONKO, New York JEFF DUNCAN, South Carolina
YVETTE D. CLARKE, New York GREG WALDEN, Oregon (ex officio)
SCOTT H. PETERS, California
FRANK PALLONE, Jr., New Jersey (ex
officio)
C O N T E N T S
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Page
Hon. Diana DeGette, a Representative in Congress from the State
of Colorado, opening statement................................. 2
Prepared statement........................................... 3
Hon. Brett Guthrie, a Representative in Congress from the
Commonwealth of Kentucky, opening statement.................... 4
Prepared statement........................................... 6
Hon. Susan W. Brooks, a Representative in Congress from the State
of Indiana, prepared statement................................. 7
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 7
Prepared statement........................................... 9
Hon. Greg Walden, a Representative in Congress from the State of
Oregon, opening statement...................................... 10
Prepared statement........................................... 12
Hon. Michael C. Burgess, a Representative in Congress from the
State of Texas, prepared statement............................. 13
Witness
Seema Verma, Administrator, Centers for Medicare & Medicaid
Services, Department of Health and Human Services.............. 14
Prepared statement........................................... 17
Answers to submitted questions \1\
Submitted Material
Article of October 22, 2019, ``The Health 202: Obamacare is
getting more affordable under the Trump administration,'' by
Paige Winfield Cunningham, Washington Post, submitted by Mr.
Burgess........................................................ 88
Letter of July 1, 2019, from Senator Cindy Hyde-Smith to Alex
Azar, Secretary, Department of Health and Human Services,
submitted by Mr. Duncan........................................ 94
Letter of March 27, 2019, from Ms. Blunt Rochester, et al., to
Alex Azar, Secretary, Department of Health and Human Services,
and Seema Verma, Administrator, Centers for Medicare and
Medicaid Services, submitted by Ms. Blunt Rochester............ 107
Letter of May 16, 2019, from Ms. Blunt Rochester to Alex Azar,
Secretary, Department of Health and Human Services, and Seema
Verma, Administrator, Centers for Medicare and Medicaid
Services, submitted by Ms. Blunt Rochester..................... 111
Letter of June 17, 2019, from Seema Verma, Administrator, Centers
for Medicare and Medicaid Services, to Ms. Blunt Rochester,
submitted by Ms. Blunt Rochester............................... 113
Letter of September 3, 2019, from Mr. Rush, et al., to Alex Azar,
Secretary, Department of Health and Human Services, and Seema
Verma, Administrator, Centers for Medicare and Medicaid
Services, submitted by Mr. Rush................................ 116
Letter of October 21, 2019, from Seema Verma, Administrator,
Centers for Medicare and Medicaid Services, to Mr. Rush,
submitted by Mr. Rush.......................................... 120
----------
\1\ The information has been retained in committee files and also is
available at https://docs.house.gov/meetings/IF/IF02/20191023/110123/
HHRG-116-IF02-Wstate-VermaS-20191023-SD002.pdf.
SABOTAGE: THE TRUMP ADMINISTRATION'S ATTACK ON HEALTHCARE
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WEDNESDAY, OCTOBER 23, 2019
House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:02 a.m., in
the John D. Dingell Room 2123, Rayburn House Office Building,
Hon. Diana DeGette (chair of the subcommittee) presiding.
Members present: Representatives DeGette, Schakowsky,
Kennedy, Ruiz, Kuster, Castor, Tonko, Clarke, Pallone (ex
officio), Guthrie (subcommittee ranking member), Burgess,
McKinley, Griffith, Brooks, Duncan, and Walden (ex officio).
Also present: Representatives Rush, Cardenas, Blunt
Rochester, Rodgers, Bucshon, Carter, and Gianforte.
Staff present: Kevin Barstow, Chief Oversight Counsel;
Jesseca Boyer, Professional Staff Member; Jeffrey C. Carroll,
Staff Director; Waverly Gordon, Deputy Chief Counsel; Tiffany
Guarascio, Deputy Staff Director; Saha Khaterzai, Professional
Staff Member; Chris Knauer, Oversight Staff Director; Kevin
McAloon, Professional Staff Member; Meghan Mullon, Staff
Assistant; Joe Orlando, Executive Assistant; Alivia Roberts,
Press Assistant; Tim Robinson, Chief Counsel; Benjamin Tabor,
Policy Analyst; Sydney Terry, Policy Coordinator; Rick Van
Buren, Health Counsel; C. J. Young, Press Secretary; Nolan
Ahern, Minority Professional Staff Member, Health; Jen Barblan,
Minority Chief Counsel, Oversight and Investigations; Margaret
Tucker Fogarty, Minority Legislative Clerk/Press Assistant;
Caleb Graff, Minority Professional Staff Member, Health;
Brittany Havens, Minority Professional Staff Member, Oversight
and Investigations; Peter Kielty, Minority General Counsel; J.
P. Paluskiewicz, Minority Chief Counsel, Health; and Natalie
Sohn, Minority Counsel, Oversight and Investigations.
Ms. DeGette. The Subcommittee on Oversight and
Investigations hearing will now come to order. Today, the
subcommittee is holding a hearing entitled ``Sabotage: The
Trump Administration's Attack on Healthcare.'' The purpose of
the hearing is to examine the efforts of the Centers for
Medicare & Medicaid Services to ensure quality and affordable
healthcare for all Americans. The Chair now recognizes herself
for 5 minutes for an opening statement.
OPENING STATEMENT OF HON. DIANA DeGETTE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF COLORADO
It is no secret that the Trump administration has worked to
sabotage healthcare in this country. On his very first day in
office, President Trump issued an executive order directing all
Federal agencies to dismantle the Affordable Care Act, ``to the
maximum extent by law.'' And ever since then, the Trump
administration has worked tirelessly to undermine the ACA and
other critical health programs at every turn.
In her role as the Administrator of the Centers for
Medicare & Medicaid Services, Seema Verma has been behind many
of this administration's efforts to undermine the Nation's
healthcare. Despite her role in this effort, today is the first
time Administrator Verma has appeared to testify in an
oversight hearing in the House, and we have many questions
regarding the administration's actions.
Since the Affordable Care Act was signed into law, more
than 20 million people gained affordable, high-quality
healthcare coverage. But now, under President Trump and
Administrator Verma, this administration is determined to take
us in the wrong direction. Last year, we saw the number of
uninsured people in this country increase for the first time
since the ACA was passed. About 1.9 million more people were
uninsured last year compared to the year before, including
nearly half a million more children. Further, the Kaiser Family
Foundation estimates that health insurance premiums are 16
percent higher this year than they would have been if the Trump
administration had not worked to undermine the ACA.
We know the Trump administration has taken numerous steps
to sabotage the ACA. They are chipping away at critical
protections guaranteed by the law. They are allowing States to
increase consumers' costs, reduce their coverage, and undermine
protections for those with preexisting conditions. They are
promoting junk insurance plans that do not provide essential
health benefits and leave patients on the hook when they need
coverage the most. They are making it more difficult and more
expensive for individuals to find quality coverage on the
health insurance marketplace, and, to top it all off, they are
rooting for the ACA's collapse by declining to defend the law
in the Texas v. United States lawsuit.
We will likely hear today that Obamacare is the source of
all our problems. But while the Nation's healthcare law may not
be perfect, it is important to understand what would happen if
the Trump administration succeeded in dismantling the ACA
entirely. Twenty-one million people could lose their health
insurance.
Up to 133 million Americans with preexisting conditions
could be denied coverage or charged higher premiums. Those
lucky enough to keep their coverage if the ACA is dismantled
could once again face lifetime caps on coverage and could lose
coverage for things like prescription drugs and maternity care.
Women could once again be charged more than men for their
health coverage, and 60 million seniors and disabled Americans
on Medicare will have to pay more for preventive care and
prescription drugs.
Yesterday, CMS announced that ACA premiums will drop by
about 4 percent this year. That is good news. However, let's
just think about how many more people would be covered now and
how much lower premiums could be if not for the repeated acts
of sabotage at the hands of this administration.
The ACA is succeeding despite the Trump administration's
efforts to tear it down. Time and time again, this
administration's actions on healthcare have gone squarely
against their duty to promote high-quality healthcare and the
well-being of children and families in need. Under this
administration, thousands of children and families have lost
coverage of basic health services, and this administration's
actions have disproportionately hurt those with disabilities,
rural Americans, veterans, women, and young people of color.
The Trump administration and Administrator Verma, in
particular, have tried to make philosophical arguments for why
they are doing these things, but the numbers just don't lie. At
a time when we as a nation are facing a series of critical
health challenges like the opioid epidemic and unacceptably
high rates of maternal and infant mortality, it is
unconscionable that this administration is working to reverse
the progress that we have made.
Today, the administration will have to answer for its
unending sabotage of Americans' healthcare, and Administrator
Verma will have to explain to the American public why she and
this administration are actively trying to take their
healthcare away.
[The prepared statement of Ms. DeGette follows:]
Prepared Statement of Hon. Diana DeGette
It's no secret that the Trump administration has worked to
sabotage healthcare in this country.
On his very first day in office, President Trump issued an
Executive Order directing all Federal agencies to dismantle the
Affordable Care Act ``to the maximum extent by law.'' And ever
since then, the Trump administration has worked tirelessly to
undermine the ACA and other critical health programs at every
turn.
In her role as the Administrator of the Centers for
Medicare & Medicaid Services, Seema Verma has been behind many
of this administration's efforts to undermine the Nation's
healthcare. Despite her starring role in this effort, today is
the first time Administrator Verma has appeared to testify at
an oversight hearing in the House, and she has many questions
to answer regarding this administration's actions.
Since the Affordable Care Act was signed into law, more
than 20 million people gained affordable, high-quality
healthcare coverage. But now, under President Trump and
Administrator Verma, this administration is determined to take
us back in the wrong direction.
Last year, we saw the number of uninsured people in this
country increase for the first time since the ACA was passed.
About 1.9 million more people were uninsured last year compared
to the year before--including nearly half a million more
children. Further, the Kaiser Family Foundation estimates that
health insurance premiums are 16 percent higher this year than
they would have been if the Trump administration had not worked
to undermine the ACA.
We know the Trump administration has taken numerous actions
to sabotage the ACA.
They are chipping away at critical protections guaranteed
by the law. They are allowing States to increase consumers'
costs, reduce their coverage, and undermine protections for
those with preexisting conditions.
They are promoting junk insurance plans that do not provide
essential health benefits and leave patients on the hook when
they need coverage the most.
They are making it more difficult and more expensive for
individuals to find quality coverage on the health insurance
marketplace.
And to top it all off, they are rooting for the ACA's
collapse by declining to defend the law in the Texas v. United
States lawsuit.
We will likely hear today that ``Obamacare'' is the source
of all our problems.But while the Nation's healthcare law may
not be perfect, it's important to understand what would happen
if the Trump administration succeeds in dismantling it
entirely:
21 million people could lose their health
insurance.
Up to 133 million Americans with preexisting
conditions could be denied coverage or charged higher premiums.
Those lucky enough to keep their coverage if the
ACA is dismantled could once again face lifetime caps on
coverage, and could lose coverage for things like prescription
drugs and maternity care.
Women could once again be charged more than men
for their health coverage.
And 60 million seniors and disabled Americans on
Medicare will have to pay more for preventive care and
prescription drugs.
Yesterday, CMS announced that ACA premiums will drop by
about 4 percent next year. This is good news. However, just
think about how many more people would be covered and how much
lower premiums could be if not for the repeated acts of
sabotage at the hands of this administration. The ACA is
succeeding despite the Trump administration's efforts to tear
it down.
Time and time again, this administration's actions on
healthcare have gone squarely against their duty to promote
high-quality healthcare and the well-being of children and
families in need.
Under this administration, thousands of children and
families have lost coverage of basic health services. And this
administration's actions have disproportionately hurt those
with disabilities, rural Americans, Veterans, women, and young
people of color.
The Trump administration, and Administrator Verma in
particular, have tried to make philosophical arguments for why
they are doing these things. But the numbers don't lie.
At a time when we, as a nation, are facing a series of
critical health challenges--such as the opioid epidemic and
unacceptably high rates of maternal and infant mortality--it is
unconscionable that this administration is working to reverse
the progress we've made.
Today, the Trump administration will have to answer for its
unending sabotage of Americans' healthcare. And Administrator
Verma will have to explain to the American people why she--and
this administration--are actively trying to take their
healthcare away.
Ms. DeGette. And with that, the Chair will recognize the
ranking member of the subcommittee, Mr. Guthrie, for 5 minutes
for an opening statement.
OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF KENTUCKY
Mr. Guthrie. Thank you, Chair DeGette, for holding this
hearing with the Centers for Medicare & Medicaid Services
today, and I would like to welcome Administrator Verma to her
first appearance before the Energy and Commerce Committee.
CMS oversees the two largest Federal healthcare programs,
Medicare and Medicaid, as well as numerous other Federal
programs. CMS programs will impact over 145 million Americans
in fiscal year 2020, and a CMS budget of over 1 trillion
represents more than 25 percent of the entire Federal budget. I
share this information about CMS not only to emphasize the
critical role that the agency plays in the Nation's healthcare
system, but to illustrate how we cannot possibly cover all of
CMS's work in a single hearing.
And thank you, Administrator Verma, for your commitment to
promoting competition and innovation for Americans' healthcare
and for that work you have accomplished in your role thus far.
Just yesterday, I was pleased to see CMS announce that premiums
for mid-level Silver plans will decrease 4 percent for 2020, a
far cry from the double-digit premium increases we have seen in
past years.
I have also heard from my constituents on how CMS's
Patients over Paperwork initiative will help providers spend
more time focusing on the quality of care provided to patients
rather than the overly burdensome administrative tasks. I am
also glad that CMS is strengthening the agency's oversight of
nursing homes in recent months. Last Congress' subcommittee
examined CMS's oversight of the quality and safety of care in
nursing homes after numerous reports described instances of
abuse and neglect in standard care occurring in nursing homes
across the country.
Another critical issue facing Americans that CMS has made a
top priority is the opioid epidemic. This committee has long
been at the forefront of the fight to combat the opioid crisis.
Last Congress, our investigation and legislative work led to
the SUPPORT for Patients and Communities Act, which was signed
into law 1 year ago tomorrow. While there is much to be done
both legislatively and through investigations, the SUPPORT Act
included important provisions relating to CMS's role and
responsibility in helping to address the opioid epidemic.
Many of the initiatives I have just described share
bipartisan support, which is why the title for this hearing,
``Sabotage: The Trump Administration's Attack on Healthcare,''
is over the top. I don't think anyone can reasonably categorize
CMS's effort to protect vulnerable populations in nursing homes
and assist States in fighting the opioid epidemic as sabotage.
Moreover, the Democrats are likely going to spend a lot of time
today criticizing CMS's recent actions relating to Medicaid
demonstration projects and Section 1332 State Innovation
Waivers. I find it disingenuous, however, to lay CMS's
commitment to strengthen its partnership with States and
promote innovation as sabotage.
I do, however, want to take some time to discuss areas
where I hope CMS will take additional action in the future. We
are at the beginning of flu season, and it will potentially be
one of the worst flu seasons that we have experienced in recent
years. This subcommittee held a hearing in 2018 examining HHS's
efforts to respond to seasonal influenza, and while CMS was not
a witness at the hearing, we did learn that FDA was working
with CMS to use Medicare data to compare the effectiveness of
different types of flu vaccines. I have some questions for CMS
today about the status of this work, and I hope that we can
hold another hearing on seasonal flu preparedness as soon as
possible.
I also have questions for CMS about the agency's efforts to
improve the interoperability of healthcare records while also
taking into consideration the sensitive nature of healthcare
data. We appreciate the work CMS has done to implement the 21st
Century Cures Act, but as I said in my letter to CMS with
Congressman Schrader this summer, I am concerned that a recent
proposed rule issued by CMS does not adequately protect
consumers' sensitive healthcare data.
Thank you again for being here today. I look forward to
your testimony, and I would like to yield my time to the
congresswoman from Indiana, Mrs. Brooks.
[The prepared statement of Mr. Guthrie follows:]
Prepared Statement of Hon. Brett Guthrie
Thank you, Chair DeGette, for holding this hearing with the
Centers for Medicare and Medicaid Services today. I would like
to welcome Administrator Verma to her first appearance before
the Energy and Commerce Committee.
CMS oversees the two largest Federal healthcare programs,
Medicare and Medicaid, as well as numerous other Federal
programs. CMS programs will impact over 145 million Americans
in Fiscal Year 2020, and CMS' budget of over $1 trillion
represents more than 25 percent of the entire Federal budget.
I share this information about CMS not only to emphasize
the critical role that the agency plays in the Nation's
healthcare system, but also to illustrate how we cannot
possibly cover all of CMS' work in a single hearing.
Thank you, Administrator Verma, for your commitment to
promoting competition and innovation for Americans healthcare,
and for the work that you have accomplished in your role thus
far.
Just yesterday, I was pleased to see CMS' announcement that
premiums for mid-level ``silver'' plans will decrease 4 percent
for 2020--a far cry from the double-digit premium increases
we've seen in years past.
I've also heard from my constituents on how CMS' Patients
over Paperwork initiative will help providers spend more time
focusing on the quality of care provided to patients rather
than on overly burdensome administrative tasks.
I am also glad that CMS is strengthening the agency's
oversight of nursing homes in recent months. Last Congress,
this subcommittee examined CMS' oversight of the quality and
safety of care in nursing homes after numerous reports
described instances of abuse, neglect, and substandard care
occurring at nursing homes across the country.
Another critical issue affecting Americans that CMS has
made a top priority is the opioid epidemic. This committee has
been at the forefront of the fight to combat the opioid crisis.
Last Congress our investigative and legislative work led to the
SUPPORT for Patients and Communities Act--which was signed into
law one year ago tomorrow. While there is still much to be
done, both legislatively and through investigations, the
SUPPORT Act included important provisions relating to CMS' role
and responsibility in helping to address the opioid epidemic.
Many of the initiatives I just described share bipartisan
support, which is why the title for this hearing, ``Sabotage:
The Trump Administration's Attack on Healthcare,'' is so over
the top. I don't think that anyone can reasonably categorize
CMS' efforts to protect vulnerable populations in nursing homes
and assist States in fighting the opioid epidemic as
``sabotage.'' Moreover, the Democrats are likely going to spend
a lot of time today criticizing CMS' recent actions relating to
Medicaid demonstration projects and Section 1332 State
Innovation Waivers. I find it disingenuous, however, to label
CMS' commitment to strengthen its partnership with States and
promote innovation as ``sabotage.''
I do, however, want to take some time to discuss areas
where I hope CMS will take additional action in the near
future.
We are at the beginning of a flu season that will
potentially be one of the worst flu seasons that we have
experienced in recent years. This subcommittee held a hearing
in 2018 examining HHS' efforts to respond to the seasonal
influenza, and while CMS was not a witness at the hearing, we
did learn that FDA was working with CMS to use Medicare data to
compare the effectiveness of different types of flu vaccines. I
have some questions for CMS today about the status of this
work, and I also hope that we can hold another hearing on
seasonal flu preparedness as soon as possible.
I also have questions for CMS about how the agency's
efforts to improve the interoperability of healthcare records
will also take into consideration the sensitive nature of
healthcare data. We appreciate the work that CMS has done to
implement the 21st Century Cures Act. But, as I said in my
letter to CMS with Congressman Schrader this summer, I am
concerned that a recent proposed rule issued by CMS does not
adequately protect consumers' sensitive healthcare data.
Thank you again for being here today, and I look forward to
your testimony.
Mrs. Brooks. Thank you, Ranking Member Guthrie. And
welcome, Administrator Verma.
Seema and her family are constituents of mine back home in
Indiana, and we actually have been friends for a couple of
decades. We worked together in Mayor Stephen Goldsmith's office
where she was focused on health policy in the late '90s. That
innovation was recognized also by former Indiana Governor Mitch
Daniels, who asked Seema to work with him in ensuring that
healthcare was working better for patients throughout Indiana.
She is the architect of the Healthy Indiana Plan, which was
Indiana's popular bipartisan--again, I repeat, it was a
bipartisan Medicaid program. Healthy Indiana Plan requires
individual responsibility through small member contributions
utilizing what are called POWER Accounts that function like
traditional HSAs, and the Healthy Indiana Plan incentivizes
preventive care to drive down costs and keep patients
healthier.
We are very, very proud that Seema Verma stepped up at the
invitation of the President to take the innovation and her
incredible dedication to the health of Americans here in
Washington, DC. We look forward to continuing working with you
to continue to improve healthcare for all Americans.
Thank you, I yield back.
[The prepared statement of Mrs. Brooks follows:]
Prepared Statement of Hon. Susan W. Brooks
Thank you, Ranking Member Guthrie. Welcome Administrator
Verma. Seema has been a dear friend throughout the years and is
a constituent of mine. Seema and I served together in Mayor
Goldsmith's office in Indianapolis in the late '90s.
She was instrumental in our home State of Indiana in making
healthcare work for patients. She is the architect of the
Healthy Indiana Plan, Indiana's popular, bipartisan Medicaid
program.
HIP requires individual responsibility through small member
contributions utilizing POWER accounts that function like a
traditional HSA. And HIP incentivizes preventative care to
drive costs down and keep patients healthier.
We are proud to have a Hoosier working for the American
people at CMS. We look forward to working with you to continue
to improve healthcare for all Americans.
Thank you and I yield back.
Mr. Guthrie. Thank you. And I yield back.
Ms. DeGette. The gentleman yields back. The Chair now
recognizes the chairman of the full committee, Mr. Pallone, for
5 minutes for purposes of an opening statement.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. I want to thank the chairwoman. Today's
hearing continues this committee's ongoing work to bring
oversight and accountability to the Trump administration's
relentless attack on people's healthcare, whether it be attacks
on the Affordable Care Act, Medicare, or Medicaid. Since day
one, the Trump administration has engaged in a concerted effort
to undermine, weaken, and outright eliminate health insurance
coverage for tens of millions of Americans.
I heard what my colleague Ranking Member Guthrie said, that
I guess he doesn't think that this administration is sabotaging
anything. But, you know, the problem I have here is, if someone
is on the right ideologically and says, ``Look, the Government
shouldn't be involved in healthcare, shouldn't get involved in
health insurance, people are on their own,'' if you said that
then I would say, ``OK, I understand. You know, you want to get
rid of all the health insurance, you want to get rid of all
this, this is not the Government's role.''
But the problem is, I hear my colleagues on the other side,
including the President, suggest otherwise. That they want to
cover everyone. That they want to help people get health
insurance. Well, I don't see that at all. I think, if you look
at this practically and not ideologically, it is clear that
fewer people have health insurance, that their essential
benefits are being cut back, they are not being covered. So to
suggest that somehow they are not responsible for that, I
think, is not true. They are responsible. It is a concerted
effort to cut back on people's health insurance, their
benefits, what kind of coverage they have.
And our witness today is the Administrator for the Centers
for Medicare & Medicaid Services, CMS, Seema Verma, who is the
administration's point person on these actions. I think she has
a difficult record to defend. During her time as the
Administrator, healthcare costs have gone up and health
insurance coverage has gone down. And thanks to the
administration's policies, the number of uninsured Americans
increased by nearly 2 million people from 2017 to 2018, rising
to 27.5 million uninsured.
And between December 2017 and this June, more than 1
million children lost health coverage through either Medicaid
or the Children's Health Insurance Program, and these are, you
know, bipartisan programs. Why is this administration making it
more difficult for people to get coverage, and particularly
kids?
These are very disturbing trends, and unfortunately they
could get even worse if CMS and the Trump administration are
successful in pushing their harmful policies. The Trump
administration is actively supporting a lawsuit that would
overturn the Affordable Care Act. This would strip health
insurance away from tens of millions of Americans and would
allow insurance companies to once again discriminate against
people with preexisting conditions.
The administration has expanded junk insurance plans that
are not required to cover essential health benefits like
hospitalization, prescription drugs, and emergency care
services. The Trump administration is also placing extremely
burdensome, in some cases illegal, hurdles in front of Medicaid
beneficiaries. These unnecessary roadblocks are certainly
causing pain for low-income families, as more than 1 million
children lost health insurance coverage through either Medicaid
or CHIP between December '17 and June of this year.
These disturbing numbers show that the Trump
administration's policies to drive people off Medicaid, tie
them up in red tape, or scare them into not even applying for
insurance in the first place are working. And I am deeply
concerned by the Trump administration's ongoing attempts to
impose illegal work requirements waivers on Medicaid
beneficiaries. These requirements are not only cruel and
costly, but they are a clear violation of both Medicaid statute
and longstanding congressional intent.
And, fortunately, these illegal actions have been
rightfully defeated in the courts, but the Trump administration
refuses to give up. And the Trump administration is also not
giving up in its ongoing attempts to sabotage the healthcare of
millions of Americans through the ACA. In some instances, the
proposals have been so extreme that even Administrator Verma
has raised the red flag. In an internal memo dated August 2018,
she wrote that several administration proposals at the time
would, and I am quoting, ``cause coverage losses, further
premium increases, and market disruption.'' And the memo
concluded that 1.1 million Americans could lose their coverage.
And I have repeatedly requested Ms. Verma provide the
underlying analysis discussed in that memo. If the Trump
administration is pursuing a policy that would have harmful
impacts on millions of Americans, Congress and the American
people have a right to know what exactly that analysis shows.
To date, I have received a one-and-one-half-page response that
answers none of my questions.
So under Ms. Verma's leadership, CMS is following the rest
of the Trump administration in stonewalling legitimate
congressional oversight requests, and I am appalled by the
flimsy, nonresponsive letters this committee has received back
from CMS, many times well past the deadline. As I wrote in a
letter to both Secretary Azar and Administrator Verma last
week, obstruction of the committee's legitimate exercise of its
oversight responsibilities is unacceptable and if continued may
necessitate the use of additional measures, including
compulsory process.
So, Administrator, you cannot flout this committee's
constitutional duty to conduct oversight. I appreciate you
being here today. That certainly says a lot that you are here,
and I don't want to take away from that. But the stonewalling
of our oversight requests have to end.
And with that, Madam Chair, I will yield back.
[The prepared statement of Mr. Pallone follows:]
Prepared Statement of Hon. Frank Pallone, Jr.
Today's hearing continues this committee's ongoing work to
bring oversight and accountability to the Trump
administration's relentless attack on people's healthcare.
Whether it be attacks on the Affordable Care Act, Medicare or
Medicaid, since day one this administration has engaged in a
concentrated effort to undermine, weaken, and outright
eliminate health insurance coverage for tens of millions of
Americans.
Our witness today is the Administrator for the Centers for
Medicare & Medicaid Services (CMS), Seema Verma, who is the
administration's point person on these actions. She has a
difficult record to defend: During her time as the
Administrator, healthcare costs have gone up and health
insurance coverage has gone down.
Thanks to the administration's policies, the number of
uninsured Americans increased by nearly 2 million people from
2017 to 2018--rising to 27.5 million uninsured. And between
December 2017 and this June, more than 1 million children lost
healthcare coverage through either Medicaid or the Children's
Health Insurance Program.
These are disturbing trends, and, unfortunately, they could
get even worse if CMS and this administration are successful in
pushing their harmful policies.
The Trump administration is actively supporting a lawsuit
that would overturn the Affordable Care Act. This would strip
health insurance away from tens of millions of Americans and
would allow insurance companies to once again discriminate
against people with preexisting conditions.
The administration has expanded junk insurance plans that
are NOT required to cover essential health benefits like
hospitalization, prescription drugs and emergency care
services.
The administration is also placing extremely burdensome
and, in some cases, illegal hurdles in front of Medicaid
beneficiaries. These unnecessary roadblocks are certainly
causing pain for low-income families--as more than 1 million
children lost healthcare coverage through either Medicaid or
the Children's Health Insurance Program between December 2017
and June of this year.
These disturbing numbers show that the Trump
administration's policies to drive people off Medicaid, tie
them up in red tape, or scare them into not even applying for
insurance in the first place, are working.
I am also deeply concerned by the Trump administration's
ongoing attempts to impose illegal work requirements waivers on
Medicaid beneficiaries. These requirements are not only cruel
and costly, but they are a clear violation of both Medicaid
statute and longstanding congressional intent. Fortunately,
these illegal actions have been rightfully defeated in the
courts, but the administration refuses to give up.
The administration is also not giving up on its ongoing
attempts to sabotage the healthcare of millions of Americans
through the ACA. In some instances, the proposals have been so
extreme that even Administrator Verma has raised the red flag.
In an internal memo dated August 2018, Ms. Verma wrote that
several administration proposals at the time would, ``cause
coverage losses, further premium increases, and market
disruption.'' The memo concluded that 1.1 million Americans
could lose their coverage.
I have repeatedly requested Ms. Verma provide the
underlying analysis discussed in that memo. If the
administration is pursuing a policy that will have harmful
impacts on millions of Americans, Congress, and the American
people, have a right to know what exactly that analysis shows.
To date, I have received a one-and-one-half-page response that
answers none of my questions.
Under Ms. Verma's leadership, CMS is following the rest of
the Trump administration in stonewalling legitimate
Congressional oversight requests. I am appalled by the flimsy
non-responsive letters this committee has received back from
CMS, many times well past the deadline. As I wrote in a letter
to both Secretary Azar and Administrator Verma last week,
obstruction of the committee's legitimate exercise of its
oversight responsibilities is unacceptable and, if continued,
may necessitate the use of additional measures, including
compulsory process.
Administrator Verma, you cannot flout this committee's
constitutional duty to conduct oversight. I appreciate you
being here today, but the stonewalling of our oversight
requests must end. With that, I yield back.
Ms. DeGette. The Chair now recognizes the ranking member of
the full committee, Mr. Walden, for 5 minutes for purposes of
an opening statement.
OPENING STATEMENT OF HON. GREG WALDEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OREGON
Mr. Walden. Well, good morning. Good morning, Madam Chair
and Chairman of the full committee.
Ms. Verma, thank you for being here. We really appreciate
it, and we have enjoyed working with you over the years on many
of these issues, and I am glad you are here.
CMS, as we have talked about, is the largest administrator
of health benefit programs in the United States. It is
estimated in fiscal year 2020 over 145 million Americans will
receive their benefits from programs administered by CMS. So
you have got a big job, and we appreciate the work you are
doing. That includes Medicare, Medicaid, and Children's Health
Insurance Program, also known as CHIP.
And under Republican leadership and with the support of
this administration and, frankly, in opposition to votes on the
floor by Democrats, we not only extended CHIP for 5 years and
then 6 years, we did it for 10. We did it for 10 years, fully
locked in, Children's Health Insurance, and a lot of Democrats,
if not all, voted against this almost every step of the way,
and especially on the House floor. And I don't want to get into
this partisan back-and-forth, I hadn't planned to today, but it
is just unfortunate because there are issues here that we need
to focus on together.
And I think about the meetings I have had with the
President, with you and others. I have not seen a President who
has leaned in more to get drug prices down. Now we may have
agreements and disagreements to policy, but I wish you could
have been here during our markup when nearly every Democrat was
holding up posters of what President Trump had said about
bringing down drug prices. And while we may have some
disagreements about the policy, they were certainly the
President's advocates last week when we were dealing with drug
costs.
In surprise medical billing, the chairman and I are working
shoulder-to-shoulder with this administration, I believe, on a
way to protect consumers from surprise medical billing. Because
I tell you, what I run into out in my part of the world is
people are so concerned about the high cost of healthcare and
in the Affordable Care Act--and we have had our debates about
what the best policies are there--it did not deliver as
promised to bring down premiums 2,500 bucks. In fact, I can't
find anybody in my district that has seen that level of
reduction in their premiums.
But what they have seen is an increase in deductibles and
copays, and insurance by name is not insurance in function if
the deductible and copays are so high you really can't afford
to access the care. And so, there are issues there in terms of
the Affordable Care Act and all, and there are things we,
frankly, as Republicans supported that became part of the
Affordable Care Act. Not the overall bill, but a lot of things
contained in there, including protecting people with
preexisting conditions, letting your kids stay on until they
are 26, there is a whole host of things.
And then we have done a lot of work together, and it was
referenced earlier today about the SUPPORT Act. As chairman of
the committee, I helped steer that through the legislative
process here. We had an open session where Members of Congress
could come and make their case. Tomorrow marks the 1-year
anniversary. I just left a meeting, bipartisan, in the Senate
with the First Lady and Secretary Azar. Well, we were
celebrating what we accomplished together as a Congress, and
almost unanimously as I recall, to address this horrible
scourge of opioids.
Now when it comes to first times, we are glad you are here,
the first time for the committee. The other first time would be
to have a hearing in this committee on Medicare for All. We
were talking about, my colleagues were talking about how the
Trump administration, their allegations, chipping away at ACA.
I would argue that their presidential candidates are taking a
chainsaw massacre approach to it, because they want to throw
out the whole thing and go with a government-run system that
wipes out Medicare and Medicaid, VA, all private health
insurance, and they are having a fight over how to pay for it
or whether to even talk about how to pay for it. And so,
working Americans are going to lose their insurance under their
plan, and I have asked for a hearing before this committee
since the first of this Congress, and we have yet to have one
on their Medicare for All proposal.
So there is a lot of debate to be had here. There are also
areas we should be working together on, and so we are glad you
are here.
[The prepared statement of Mr. Walden follows:]
Prepared Statement of Hon. Greg Walden
Thank you. I'd like to welcome the witness for today's
hearing--Seema Verma, Administrator of the Centers for Medicare
and Medicaid Services (CMS). We are pleased that you are here
today to discuss the operations of CMS.
CMS is the largest administrator of health benefit programs
in the United States. It is estimated that in Fiscal Year 2020,
over 145 million Americans will receive benefits from programs
administered by CMS--including Medicare, Medicaid, the
Children's Health Insurance Program, also known as CHIP, and
the Exchanges. CMS' budget request for Fiscal Year 2020 was
nearly $1.7 trillion, and two of the programs administered by
CMS--Medicare and Medicaid--are estimated to account for 86
percent of all projected spending in 2020 for the U.S.
Department of Health and Human Services (HHS).
Given the breadth of programs administered by CMS, and that
these programs represent a substantial financial obligation for
the Federal Government and the States, it is important that
this committee conduct oversight of the agency that administers
those programs. Last Congress, under my leadership as chairman,
we conducted oversight on a range of issues that fall under
CMS' purview. It was this subcommittee that conducted the
necessary oversight to help ensure that programs operate
effectively, tax dollars are spent appropriately, and that
Americans who benefit from these programs receive the quality
of care that they deserve.
Specifically, the committee conducted oversight over
programs such as Medicaid, looking at data integrity and
innovation, the 340B Drug Pricing Program, hospital accrediting
organizations, and nursing homes, to name a few. The oversight
of these programs consisted of letters, document requests,
hearings, briefings, roundtables, meetings with stakeholders,
and in some cases, reports with recommendations on ways to
improve the administration and oversight of these programs.
But oversight hasn't been our only focus. Last Congress,
this committee worked tirelessly on legislation to improve some
of the programs and services administered by CMS. For example,
we led the effort to pass the Substance Use-disorder Prevention
that Promotes Opioid Recovery and Treatment--or SUPPORT--for
Patients and Communities Act.
Everyone knows someone impacted by the opioid crisis.
Everyone pictures a different face when they think of it. There
are many people who come to mind for me from stories shared at
roundtables I held across Oregon--like a mother I met earlier
this month in La Pine who shared a poem about the son she had
recently lost to an overdose. Whether it be parents,
physicians, or law enforcement officials--everyone I've talked
to has a story to tell, and everyone has urgency in their eyes
to stop this epidemic.
Tomorrow marks the 1-year anniversary of the SUPPORT Act
becoming law, which is a point of pride for this committee and
the administration. But we must also remain vigilant in our
efforts to combat the opioid crisis and continue to help
patients and communities move ``forward with support.''
Among other things, the SUPPORT Act included provisions to
strengthen law enforcement, public health, and healthcare
financing and coverage, including under the Medicare and
Medicaid programs. For example, under Section 1003, CMS, in
consultation with another division within HHS, is conducting a
54-month demonstration project to increase the treatment and
capacity of Medicaid providers to deliver substance use
disorder treatments and recovery services. CMS' first step to
implement this section just occurred in June, when the agency
announced a Notice of Funding Opportunity that provides State
Medicaid agencies with information to apply for planning grants
that will aid in the treatment and recovery of substance use
disorders.
In addition, the 21st Century Cures Act (Cures), signed
into law in December 2016, made numerous changes to Medicare
and Medicaid policies, including, but not limited to,
provisions impacting infusion drug reimbursement, durable
medical equipment policies, telehealth, hospital readmissions,
long-term care hospitals, and reimbursement policies for
hospital outpatient departments.
It is critical that we continue to have a dialogue and
conduct oversight of CMS to ensure that the implementation of
the SUPPORT Act, Cures, and other legislation passed by this
committee are implemented and administered as intended, and on
schedule. It is also important to continue our work to ensure
proper administration and oversight of other programs
administered by CMS.
I, again, welcome Administrator Verma and thank you for
being here today. I look forward to listening to your
testimony.
Mr. Walden. I am going to yield now to the ranking member
of the Health Subcommittee, Dr. Burgess.
Mr. Burgess. I thank the gentleman for yielding. I would
like to do something I don't normally do, which is quote from
the Washington Post. In the Health 202 article yesterday by
Paige Cunningham, it states, ``Obamacare premiums will become
more affordable next year--despite the dire predictions by
Democrats that the Trump administration would destroy the
insurance marketplaces.'' She goes on to say, ``The
improvements are striking, considering that Democrats have
spent the last few years blasting the Trump administration for
peeling away Obamacare regulations.''
Quoting Alex Azar, ``President Trump, the President who was
supposedly trying to sabotage the law, has been running it
better than the guy who wrote it.'' Quoting President Trump
himself, `` `Once we got rid of the individual mandate it made
it better, but Obamacare doesn't work--but it works at least
adequately now. And we had that choice to make. And politically
it is probably not a good thing that I did, but it's the right
thing to do for a lot of people,' he said in July.'' So I will
just submit this entire article for the record. I ask unanimous
consent to do so.
Ms. DeGette. Without objection.
[The information appears at the conclusion of the hearing]
Mr. Burgess. And we will carry on. I yield back. Thank you.
[The prepared statement of Mr. Burgess follows:]
Prepared Statement of Hon. Michael C. Burgess
Administrator Verma, thank you for being here today. I
appreciate your willingness to engage with me and with the
Energy and Commerce Committee over the course of your tenure at
the Centers for Medicare and Medicaid Services.
I especially want to thank you for your work on providing
coverage of cardiac stenting in ambulatory surgical centers. I
would also like to mention that the proposed Stark Law and
Anti-Kickback Statute reforms as a step in the right direction
for patients and physicians. You have been a great partner in
shifting our payment system to reward value over volume, and I
look forward to continuing to work together.
Ms. DeGette. The gentleman yields back. The gentleman
yields back. The Chair now asks unanimous consent that Members'
written opening statements will be made part of the record.
Without objection, they will be entered.
I would now like to introduce our witness for today's
hearing, Hon. Seema Verma, Administrator, Centers for Medicare
& Medicaid Services, U.S. Department of Health and Human
Services.
Administrator Verma, thank you so much for coming today.
You are aware, I know, that the committee is holding an
investigative hearing, and when doing so we have the practice
of taking testimony under oath. Do you have any objections to
testifying under oath?
Ms. Verma. I do not.
Ms. DeGette. Let the record reflect the witness responded
no. The Chair then advises you, under the rules of the House
and the rules of the committee, you are entitled to be
accompanied by counsel. Do you desire be accompanied by counsel
today?
Ms. Verma. I do not.
Ms. DeGette. Let the record reflect the witness has
responded no. If you would, then, please rise and raise your
right hand so that you may be sworn in.
[Witness sworn.]
Ms. DeGette. You may be seated. Let the record reflect the
witness responded affirmatively. And you are now under oath and
subject to the penalties set forth in Title 18, Section 1001 of
the U.S. Code.
The Chair now recognizes the witness for a 5-minute summary
of her written statement.
In front of you is a microphone and a series of lights. The
light turns yellow when you have a minute left, and it turns
red to indicate your time has come to an end.
You are now recognized.
STATEMENT OF SEEMA VERMA, ADMINISTRATOR, CENTERS FOR MEDICARE &
MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
Ms. Verma. Thank you. Chair DeGette, Ranking Member
Guthrie, and members of the subcommittee, thank you for the
invitation to discuss efforts by the Centers for Medicare &
Medicaid Services to transform and improve the United States
healthcare system. When I came to CMS, our goal was to improve
quality, lower costs, and improve the healthcare experience not
only for the beneficiaries of our programs but for all
Americans.
In 2017, this administration inherited a chaotic and
declining individual health insurance market. The relief
promised by proponents of the Affordable Care Act never
materialized. Quite the opposite. Premiums in States using the
Federal exchange more than doubled from 2013 to 2017, the final
year the previous administration oversaw the program. Issuers
were fleeing the market, and we were scrambling to prevent bare
counties.
But after just over 2\1/2\ years as Administrator, I am
happy to report that our market-based reforms have delivered
lower premiums on the exchanges for the first time since the
law started. Yesterday, we announced that for 2020 the average
premium for a benchmark Silver plan will drop by 4 percent in
States using the Federal exchange platform. This is on top of
the decreases we saw last year.
In some cases, the decline in premiums is substantially
higher, with 6 States experiencing double-digit percentage
decreases, including a 20 percent drop in Delaware, a 15
percent drop in North Dakota, and a 14 percent drop in
Oklahoma. On top of this, more issuers are entering the market,
and the number of States with just a single monopoly issuer is
declining. Only 2 States will have a single issuer in 2020,
compared to 5 this year and 10 last year. This is success.
Despite this progress, it was inevitable that Obamacare's
affordability crisis would eventually increase the number of
uninsured, and that is exactly what the latest census data
show. The fact is, 85 percent of the 1.9 million newly
uninsured in 2018 occurred among people with incomes higher
than 300 percent of the Federal poverty level. These are people
who do not qualify for large ACA subsidies and represent a new
class of uninsured, those that can't afford Obamacare's
premiums.
Our work to lower premiums hasn't stopped with the
exchanges. Under the President's leadership, we have
strengthened Medicare, seeing similar success in Medicare
Advantage and Part D. Medicare beneficiaries have more choices,
with about 1,200 more Medicare Advantage plans available in
2020 than in 2018. Average monthly premiums in Medicare
Advantage are the lowest they have been in 13 years, and in
Medicare Part D, the lowest they have been in 7 years.
Across the board in Medicare and the exchanges, premiums
are lower. All of our work at CMS focuses on making healthcare
more affordable and accessible to the American people. We are
using every lever and our large footprint to tackle
longstanding issues and problems in the healthcare system. We
are executing on our vision to transform care by putting
patients first and focusing 16 strategic initiatives grounded
in empowering patients, promoting competition, and unleashing
innovation. CMS is committed to moving to a system of
competition and value and giving patients the choice and
control they want, the affordability they need, and the quality
they deserve.
While my written testimony provides more details, I will
highlight a few of our efforts on these initiatives. We are
empowering patients with the information they need to make
decisions about their healthcare. We have efforts underway
around price transparency, quality transparency, and ensuring
that beneficiaries' medical records can travel with them while
keeping the data private and secure.
We're addressing issues that drive up healthcare costs,
especially administrative costs. After becoming Administrator
of CMS, one of my first actions was to launch the Patients over
Paperwork initiative. Across our programs we have made
commonsense changes to our regulations and guidance. Just last
week, for example, we released a proposed rule to modernize and
clarify the regulations that interpret the Stark Law. Our new
policies will save providers an estimated 4.4 million hours a
year previously spent on paperwork, with savings projected to
be approximately $8 billion dollars over the next 10 years.
We're also working to bring our programs into the 21st
century. Last year, the administration launched the eMedicare
and the MyHealthEData initiatives to modernize Medicare and
meet the growing needs of a number of tech-savvy beneficiaries.
This includes releasing two new cost calculator tools and the
first redesign of Medicare Plan Finder in a decade. And as part
of MyHealthEData, Blue Button 2.0 is already giving Medicare
beneficiaries the ability to securely connect their claims data
to apps and other tools developed by innovators.
We have launched several historic efforts to improve
quality and safety in nursing homes and across the healthcare
system to improve rural health, to transform our program
integrity efforts and to foster innovation throughout the
American healthcare system, bringing new technology and
breakthrough treatments to our beneficiaries. And we're also
focused on transforming the Medicaid program around three
pillars: flexibility, integrity, and accountability. Our goal
is to restore the Federal-State partnership in Medicaid and
allow States to resume their role as laboratories of
innovation.
We are approving groundbreaking waivers and doing it at a
faster pace, and we are holding States accountable for results,
including through our new Medicaid scorecard. At CMS, we are
putting patients first----
Ms. DeGette. The gentlelady's time has expired, if you can
wrap up, please, Administrator.
Ms. Verma. At CMS, we are putting patients first as we move
forward with transforming the healthcare system and providing
all Americans with an access to a variety of affordable
coverage options.
Ms. DeGette. Thank you.
Ms. Verma. I greatly appreciate the opportunity today.
[The prepared statement of Ms. Verma follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. It is now time for Members to ask you
questions, and I will recognize myself for 5 minutes.
Administrator Verma, as I stated in my opening and as you
mentioned in your statement, we saw the number of uninsured
people in this country increase last year for the first time
since the ACA was passed to about 1.9 million people, is that
correct?
Ms. Verma. That is correct.
Ms. DeGette. And about half of those people were children,
is that right?
Ms. Verma. I don't think that number is correct, no.
Ms. DeGette. OK. What is the correct number then?
Ms. Verma. I think the number's around 400,000.
Ms. DeGette. Four hundred thousand, thank you. Now, in the
Texas v. United States case, that is the case that the
administration has requested that the ACA be struck down, is
that correct?
Ms. Verma. That is correct.
Ms. DeGette. And so, any day now the court will rule, and
if the court rules the way the administration has asked, then
the entire ACA will be invalidated, is that correct?
Ms. Verma. That is correct.
Ms. DeGette. OK. So now, if the ACA was invalidated, about
21 million people would lose their health insurance, is that
correct?
Ms. Verma. I think what's clear----
Ms. DeGette. Yes or no will work.
Ms. Verma. No.
Ms. DeGette. No, OK. How many people would lose their
health insurance if the ACA was struck down, do you know?
Ms. Verma. The President has made clear that we will have a
plan in action to ensure that Americans have access.
Ms. DeGette. OK. I am going to get to that in a minute. But
if the ACA was struck down, isn't it true 12 million people
would lose their insurance?
Ms. Verma. The President has made clear----
Ms. DeGette. No. Yes or no will work. Do you know how many
people would lose their insurance?
Ms. Verma. The President has made clear----
Ms. DeGette. OK, you are not going to answer that. Now let
me ask you this. Let me ask you this: If the ACA was struck
down, then also the provision of the preexisting conditions
would be struck down since it is part of the ACA, is that
right?
Ms. Verma. The President has made clear that we will do
everything we can to ensure that Americans with preexisting
conditions maintain the protection that they have today.
Ms. DeGette. Well, let me just say then, since you are not
answering my question: The ACA, if it was struck down, this is
what would happen. Twenty-one million people who are insured
under the ACA would lose their insurance. That includes 12
million people on Medicaid and 9 million who have ACA
protection. There are currently 133 million people with
preexisting conditions who under the ACA get protections.
Now there is about--I will ask you this. Maybe--I am sure
you will give the same answer, but there are 2.3 million adult
children under the age of 26 who because of the ACA are able to
stay on their parents' insurance. Now, I will ask you this: If
the ACA was struck down, would those 2.3 million adult children
still have their insurance?
Ms. Verma. The President has made clear----
Ms. DeGette. OK.
Ms. Verma [continuing]. That we will maintain what works,
and we will try to address the problems that we're having with
the ACA.
Ms. DeGette. So did the administration file some kind of a
motion in the Texas case to say that the preexisting conditions
should be maintained? Yes or no will work.
Ms. Verma. Individuals that have preexisting conditions
today----
Ms. DeGette. Yes.
Ms. Verma [continuing]. That do not receive a subsidy, I
would argue that they don't have the protections today. I mean
if we give you an example of the 55----
Ms. DeGette. So you don't think the ACA is protecting
people with preexisting conditions?
Ms. Verma. If you can't afford your health insurance, if
you can't afford health insurance and you have a preexisting
condition, then you don't have protections.
Ms. DeGette. OK. What about the adult children? Did the
Trump administration file a motion with the court to say they
should still be able to stay on their parents' insurance until
age 26? Yes or no.
Ms. Verma. The President has made clear that we will have a
plan in action to make sure that Americans have access to
affordable coverage. We do not have that today. There are many
Americans today, if they are not getting a subsidy, can't
afford health insurance today.
Ms. DeGette. I totally understand your position,
Administrator Verma. You are not answering my questions
because, frankly, if the ACA was struck down the preexisting,
people with preexisting conditions, the adult children, all of
those provisions of the ACA would be reversed. So you are
telling me, Administrator, that the Trump administration has
told people they will be protected. Can you produce for me
right now the Trump administration's plan to protect the
people? Can you produce that plan right now?
Ms. Verma. So today, a 55-year-old couple making $60,000 a
year----
Ms. DeGette. No, no. That is not my question.
Ms. Verma [continuing]. In Nebraska----
Ms. DeGette. My question--excuse me. My question is, do you
have a copy of the plan that will replace the ACA? Yes or no.
Ms. Verma. I'm not going to get into any specifics of a
plan, but the----
Ms. DeGette. OK, you are not going to answer the questions.
In that case, the Chair will yield back, and she will recognize
the ranking member for 5 minutes.
Mr. Guthrie. Thank you, Administrator. Do you want to
finish your comments you were just making?
Ms. Verma. Thank you. So a 55-year-old couple making
$66,000 a year in Grand Island, Nebraska, could face an annual
premium of over $31,000, and that's on top of a $12,000
deductible. In that same situation in Colorado, that premium
would be $32,800. In New Jersey, the premium would be almost
$16,000. So we're talking about people having to spend a third
to a half of their income on premiums, and that doesn't even
include the deductibles.
And so, if those individuals or that couple have a
preexisting condition, they don't have any protections today.
Mr. Guthrie. So I was going to talk about the lowering
premiums, but you are lowering for minority very high premiums
that increased since the ACA was passed. So the lower--but you
have made efforts and put into place the lowering. What
challenges remain to further lowering premiums?
Ms. Verma. Well, I think one of the things that we need to
do is focus on lowering the cost of care. There's been so much
discussion about throwing more money, you know, at the problem,
having more government control, but what we're focused on is
lowering the cost of healthcare. Many of the initiatives that
we have at CMS, whether it's around drug pricing, whether it's
getting rid of administrative burdens that are getting in the
way of doctors spending time with their patients and actually
increasing costs, whether it's focusing on efficiencies in the
system like interoperability and making sure that patients have
access to their healthcare records, we are trying to focus on
actions that are going to lower the cost of care for Americans.
If we do that, more people will be able to afford healthcare.
Mr. Guthrie. Thanks. And I want to switch a little bit. I
have some Kentucky hospitals that have contacted me about the
star rating system before, and their question is they
understand the purpose, but it doesn't adequately, or--reflect
the quality that they produce at their hospitals. So I know CMS
decided to change the hospital star rating methodology, and so
my question is that some stakeholders requested CMS remove or
suspend star ratings from Hospital Compare website until the
hospital star rating methodology is updated, but what does CMS
plan to use the current methodology to update star ratings in
early--can you, an estimate for the fix of this?
Ms. Verma. Sure, and I appreciate the question. So, first
of all, let's start with as we are focusing on lowering
healthcare costs. We think that price transparency is very
important, and along with price transparency quality
transparency is important, and that's what the hospital star
ratings are all about.
I appreciate the comments and the concerns that hospitals
have raised about their methodology, and we've made it clear
that we want to work with them so we can make sure that
Americans have access to quality information that's going to
give them the best understanding of what type of hospital and
what kind of issues that hospital may have, so we are dedicated
to working with them. In the meantime, though, we want to be
able to use what we have because we think it's important for
patients to have that information.
Mr. Guthrie. Thank you very much.
Ms. Verma. But we will work with them.
Mr. Guthrie. Thank you very much. And last week or the week
before last, I think, last week we had a markup on a drug
pricing bill here. And then the big concern that I have had,
and one of the great things that has been bipartisan was the
Cures Act, the things that we moved here. And being in DC, when
I talk to people back home that things are working and things
are moving forward, it is the blockbuster drugs that are coming
out, the blockbuster procedures. In the bill that was--the CBO
estimated that 10 to 15 remedies or cures would not come
forward because of the impact of the bill.
And there were a couple of Members on the other side, one
that said 10 to 15 would be something to, you would just have
to sacrifice for the fact of being able to negotiate lower drug
prices. One said that, well, if we have these blockbuster
cures, we can't afford them, then what good are they, so
essentially they are not--the bill is better than those cures.
And I just, my comment was, well, let's come up with the
blockbuster cures and figure out how to pay for them and not
lose them, because what if that one is Alzheimer's, diabetes, I
mean all the things that are out there.
So my question is I get to--is one of the ways is value-
based arrangements, and I know there are certain things such as
Stark Law and other things that kind of get in the way of
trying to do the value-based arrangements. Could you talk about
value-based arrangements and pay, value-based arrangements for
dealing with expensive cures?
Ms. Verma. Sure. Well, I appreciate the question, and I
think we are seeing the advent of new high-cost drugs. We've
seen drugs priced at a half a million dollars, a million
dollars, two million dollars. I mean, those are providing hope
for so many patients because these new medications can actually
cure diseases and can actually prevent some downstream costs
for the healthcare system over the long term, so they can
actually reduce costs.
That being said, I don't think that our system is set up to
handle this. In the Part B program, we pay the average sales
price plus an add-on of right now it's about 4\1/2\ percent
with a sequester. But it's an add-on payment, so if you think
about paying an average sales price of a million to two million
dollars, plus an add-on, I don't think the system can handle
it. That being said, we do need to think about value-based.
Ms. DeGette. The gentleman's time has expired. The chair
now recognizes the gentlelady from Illinois, Ms. Schakowsky,
for 5 minutes.
Ms. Schakowsky. Thank you.
Administrator Verma, your testimony before us, you said
that ``the individual market was in a state of crisis because
of the ACA.'' But in reality, it is you and the Trump
administration who have done everything you can to sabotage the
ACA and reverse the law's historic gains in health coverage. So
let's go over some of the record of the past 3 years, your
record.
On his--and the President's. On his first day in office,
the President signed an executive order directing Federal
agencies to undermine the ACA ``to the maximum extent permitted
by law.'' Days later, CMS pulled the funding for outreach and
advertising for the final days of 2017 enrollment, an action
estimated to have reduced enrollment by a half a million
people.
You cut the number of days people could sign up for
coverage by half. You spent funds meant for promoting the
enrollment on a public relations campaign to undermine the law.
HHS changed its website, HealthCare.gov, making it more
difficult for consumers to obtain appropriate health coverage.
For 2018 open enrollment, you cut the outreach advertising
budget by 90 percent, which resulted in as many as 1 million
fewer people gaining access to coverage.
You ordered the regional directors to stop participating in
open enrollment events. In 18 cities, including my hometown of
Chicago, you terminated contracts for in-person assistants who
guide applicants through the ACA enrollment process and was
designed to help them sign up for insurance, and those are now
gone. You slashed funding for nonprofit navigator groups that
help people shop for better coverage and you stopped making
cost sharing reduction payments to insurers even though CBO
warned that failure to make these payments would increase--that
would increase premiums by 20 percent and add nearly $200
billion to the national debt.
And time and time again this administration, including you
and President Trump himself, have used inflammatory rhetoric to
spread falsehoods and misinformation about the ACA. And though
you have slashed funding for ACA enrollment outreach, you have
certainly pushed taxpayer funds elsewhere. According to a press
report, you personally approved the awarding of millions of
dollars of Federal contracts to Republican communications
consultants who write your speeches, polish your brand, and
travel with you across the country. This calls into question
your stewardship of critical CMA resources that could be put to
good use to give people coverage.
Administrator Verma, it is simply your tenure that has
focused on undermining the ACA. We received a report yesterday
that premiums will go down by 4 percent in 2020, but imagine
how much more money Americans could have saved if you were
uplifting the ACA and helping them to get coverage. President
Trump has said that his only plan is to ``let Obamacare fail.''
But you have gone further than that. You are actually
sabotaging the law. You have led the effort, Administrator
Verma. And, you know, you say--we have heard for 10 years now,
well, actually since the passage of the ACA, that Republicans
wanted to repeal and replace the law. Now you are telling us if
there is a court decision very soon that overturns the
Affordable Care Act, that you have a plan.
Where is the plan? Do you have a plan that you can present
to us or is this another pie-in-the-sky promise----
Ms. DeGette. The gentlelady's time has expired.
Ms. Schakowsky [continuing]. That we have heard for many
years?
Ms. DeGette. The Chair now recognizes the gentleman from
Texas, Mr. Burgess, for 5 minutes.
Mr. Burgess. I thank the Chair for the recognition. Just a
point, here. For plan year 2017, navigators received $62.5
million in grants and enrolled 81,000 individuals. There was a
group of 17 navigators who enrolled less than 100 people,
costing the taxpayers $5,000 per enrollee. Contrast: agents and
brokers are able to enroll people at a much more cost-effective
rate. We have had this discussion many times before in this
committee.
Ms. DeGette. Will the gentleman yield?
Mr. Burgess. No, I will not. You know my time is limited.
You have a quick gavel.
So, let me just ask you this: Which is the more cost-
effective way of enrolling people? Is it navigators, or is it
agents and brokers?
Ms. Verma. I think the answer to that is agents and
brokers. What we have found with the navigator program is that,
when we looked at the numbers, we found that the navigator
programs weren't meeting their goals. And that, in fact,
despite the spending they were actually enrolling less than 1
percent of all the enrollments. And when we did the math,
sometimes we were spending $5,000, $7,000 per person for these
navigator programs.
And so, we felt like there was a better way. If we looked
at the previous administration, they had doubled their
advertising budgeT, and even after they doubled the advertising
budget, enrollment went down, and so we sought for a more cost-
effective way. And all of our contracts at the agency are
focused on promoting the work of the agency, and we focused on
finding new and cost-effective ways of enrolling people, like
digital ads, and those have been proven to be effective.
Under our administration, premiums are lower. There are
more choices. We have a 90 percent satisfaction rate at our
call center for open enrollment, which has not happened before.
It has only happened under our tenure. And because of the
changes that we've made, because we've had a more efficient
program, we're even actually able to use those savings to lower
the user fees. We did that last year, and I hope to be able to
do that again in the future.
Mr. Burgess. That is an incredible figure about the call
centers. And when the implementation of the Affordable Care Act
came online in October of 2013, I did not take the special deal
that Members of Congress afforded themselves. I went through
HealthCare.gov, and that phone interaction took 4 months to
actually accomplish, and it was one of the most miserable
experiences I had ever been through in my life. So thank you
for improving the customer experience at that end. A lot of
times people don't care about the politics, they just need the
deliverable, and it sounds like you are working hard on that.
Thank you for your commitment to Mr. Guthrie on--we will be
working on the next version of the Cures bill at some point
over the coming months and, really, we do want to involve you
and your office, members of the agency, in some of these
fantastic gene therapies and self-therapies that are coming
down the pike where a single shot may cure some significantly
costly disease. And Mr. Guthrie is right. We have to have a way
with value-based purchasing or amortizing that cost over a
longer period of time, and certainly look forward to your help
as the committee develops--no good to develop the cure if no
one can afford to take it.
Let me just ask you a question, if I could, on prior
authorization. I get a lot of comments from my physician
colleagues about prior auth. What are you doing to make the
prior authorization, your Patients over Paperwork, how are you
trying to reduce the burden of prior auth?
Ms. Verma. Well, that is a issue that I hear a lot about
from providers on the front line. We did a national listening
tour, and I will say that was one of the number-one issues that
physicians are complaining about, with good cause. As part of
our Patients over Paperwork initiative, we've put out RFIs and
we've heard from both sides on this.
I can tell you right now that I have a group of individuals
at the agency that's working on how we can figure out how to
ensure that we have the appropriate protections in place for
program integrity, because that's necessary. We want to make
sure that evidence-based treatment is being provided to our
beneficiaries, but at the same time the process can be
burdensome.
Mr. Burgess. Yes.
Ms. Verma. And it can get in the way of providing good
patient care. It can create delays in care. So we're working on
it, and you can expect to see some action this year on that.
Mr. Burgess. I appreciate that. Let me just try to get one
additional question. We have had a lot of discussion in this
subcommittee and Health Subcommittee both last Congress and
this Congress on the issue surrounding maternal mortality. Had
a very good hearing the other day with Dr. David Nelson, the
residency director at Parkland Hospital, where I trained, in
talking about his experiences at Parkland. Are there any tools
that CMS does not currently have that would be helpful in
addressing maternal mortality?
Ms. Verma. Well, this is something that I started my career
on, working on the area of maternal and child health, so it's a
very important issue to me. We've had a conference on this
issue. Some of the things that we're working on is streamlining
eligibility, so as women are on Medicaid and then moving to the
exchanges that we can make that process work better.
Ms. DeGette. The gentleman's time has expired. The Chair
now recognizes the chairman of the full committee, Mr. Pallone,
for 5 minutes.
Mr. Pallone. Thank you, Madam Chair. And I just want to
pick up on the statement, you know, the questions you said
about the administration's decision to ask the courts to strike
down the ACA and the Republican lawsuit that is seeking to
declare the entire ACA invalid. Obviously, if the district
court ruling is upheld, Ms. Verma, you will be responsible for
the largest coverage loss in U.S. history, or at least the
President would be responsible for the largest coverage loss in
U.S. history. Over 20 million Americans would lose their
coverage, raising consumer costs and making lifesaving
healthcare unaffordable for American families.
Now, again, you know, as I said in my opening, if, you
know, everybody on the right said, ``Oh, that is fine because
we don't want the Federal Government to do anything about
people's healthcare''--but that is not what I hear from Trump
or my Republican colleagues. They say they want to provide
health insurance even though they are sabotaging everything.
So I wasn't here, but I want to know, does the President
have a plan, and what is the plan? I mean, it sounds almost
like there is some kind of secret plan that he doesn't want to
reveal. Could you just tell us? What is the President's plan?
Some information about his plan in the event that he is
successful in this awful lawsuit, what is the plan?
Ms. Verma. Well, I am not going to get into any specifics
of the plan, but what I will say is that the President's
healthcare agenda has been in action from day one. Our
commitment to lower the cost of healthcare----
Mr. Pallone. No, but I am not asking about that. You know,
I disagree with you that he has had a plan so far other than to
sabotage the ACA. But what I am asking is, if the court strikes
down the ACA in this lawsuit, what happens then? What is he
going to do next? What is his plan to deal with the reality
that all these people wouldn't have health insurance?
Ms. Verma. We have planned for a number of different
scenarios, but we need to hear from the courts. The President
has made his commitment clear that he wants to make sure that
people with preexisting conditions have protections, that
Americans have access----
Mr. Pallone. Well, I know. But you are not giving me any
details other than saying that he is going to give us
something. So, look. I think that the administration----
Ms. DeGette. Will the gentleman yield?
Mr. Pallone. Sure.
Ms. DeGette. In the court, the administration asked for the
entire Affordable Care Act including----
Mr. Pallone. Right.
Ms. DeGette [continuing]. The preexisting conditions and
the kids to 26 and the gender disparities and everything, they
asked for the entire thing to be struck down.
Mr. Pallone. Right, right.
Ms. DeGette. They didn't ask for certain portions of the
ACA to be retained.
Mr. Pallone. But you see, this is my problem. And I want to
move on to another topic, but my problem is, again, if the
administration--if the President was honest and said, ``Look, I
am just going to--I want to get rid of the ACA. I don't have
anything else. I don't think people, you know, the Federal
Government should be involved in healthcare, you are on your
own,'' then I would say, ``OK, that is your ideology. I don't
agree with it, but I understand that is where you are coming
from.'' I just think it is so deceptive, though, to suggest
that somehow we are going to cover everybody and we are going
to do something better, but not give us anything. And you are
not giving us anything.
But let me go back to my other issue with, that I mentioned
before about not being responsive. In June I sent you and
Secretary Azar letters requesting--oh, I am going back to this
memo.
In April, you finalized a marketplace rule that changed the
formula for ACA's subsidies despite your own objections to the
policy, and I appreciate your objections. In fact, in an
internal memorandum to Secretary Azar dated August 2018, you
wrote that, I quote, ``I recommend not moving forward with this
policy and that such a policy would cause coverage losses,
further premium increases, and market disruption.'' And you
cautioned that if the policies under consideration are adopted,
and I quote, ``exchange enrollment would decline by 1.1
million,'' and you wrote that these actions could result, I
quote, ``potentially, in bare counties or States with no
subsidized coverage available.''
My question is, do you still believe that this policy would
likely result in families losing coverage?
Ms. Verma. I think there are several policies in that memo.
I am comfortable with the final rule and where we came out, and
I think that the evidence is clear that premiums are lower.
Mr. Pallone. All right.
Ms. Verma. We have more choices available on the exchanges,
so the actions that we have taken have resulted in Americans
having more choices about their healthcare----
Mr. Pallone. Well.
Ms. Verma [continuing]. And have lower premiums for the
first time since the Affordable Care Act started.
Mr. Pallone. All right, I understand that. That--in June I
sent you and the Secretary letters requesting the underlying
analysis that is discussed in the memo and the analysis of the
impact of those policies conducted by CMS Office of the
Actuary, and last week I sent you and Secretary Azar a followup
letter reiterating my request. I requested a complete response
to my letter by October 30th, but so far, as I have said, I
have received a one-and-a-half-page response that answers none
of my questions, not a single document. Your response has been
unacceptable, and Congress and the American people have a right
to know what exactly the analysis shows.
So, again, would you commit to providing those documents to
my letter by October 30th?
Ms. Verma. CMS is a subagency. We are under HHS, and all of
the documentation requests are handled by HHS, and so I would
refer your question to the agency.
Mr. Pallone. Well, I mean that is a really poor excuse.
Ms. DeGette. The gentleman's time is expired.
Mr. Pallone. Thank you.
Ms. DeGette. The Chair now recognizes the gentleman from
West Virginia, Mr. McKinley, for 5 minutes.
Mr. McKinley. Thank you, Madam Chairman.
Administrator, I think we virtually owe you an apology for
the way you have been treated here. I have been--I go home
every weekend, and I talk to the people. West Virginia, yes, is
a red State. I was in Indiana the weekend before, a red State.
But I was in Boston for a meeting up there, and I heard the
same thing from people on the street, and we talked to the
waitresses at how people--what is going on in Washington. And
they talked about the tone, the accusatory language that is
used, the lack of civility.
And today I think it has hit a new point by this word
``sabotage.'' Probably been, we are 42 times already today it
has been used, like someone found it in a new dictionary that
they want to use to try to stir up things. People are appalled
by this, and they want us to work together, and to accuse you
and this administration the way they have, I apologize for
that.
Ms. Verma. Thank you.
Mr. McKinley. Now, let me ask you a couple questions,
however, and that is in West Virginia and Appalachia we are
disseminated with the opioid crisis, and we are trying to find
ways of can there be something set up. So I am going to go away
from what they want to--their sandbox they want to play in. I
want to--what are ways that we can provide some additional
funding or something for nonopioid rehabilitation treatment?
Because we have got--there are incentives all for using
opioids, but what about some of the other nonopioids?
Could you come back with--when you all put together your
rule, there is nothing in there about that, the nonopioid
treatment, and I really hope that we can do that. Can we work
together, Administrator, on that?
Ms. Verma. Sure. CMS has worked with State Medicaid
programs. We've actually approved 26 State Medicaid 1115
demonstrations, which permit States to expand services for care
for substance use disorder in institutions for mental disease
and we have actually been working to implement all the sections
of the SUPPORT Act that relate to CMS.
In relation to your question, I will have our Office of
Legislation reach out to you and your staff to work on that.
Mr. McKinley. If you could, I would like to follow up with
that. And the other is, and it began, again, I am not going to
trash this administration and I am not going to trash the
previous administration. We just have difference of opinions,
but we can talk to each other. But what we asked under the
Obama administration was, where did the--for the
rehabilitation, for the Medicaid, Medicare, 28 days--where did
that come up with? And no one has ever gotten back to us on
that with--so, I am curious, to you, do you have an opinion?
Is--and it is a trick question here, is 28 days enough for
rehabilitation for someone deep in drugs?
Ms. Verma. Well, I'd like to consult with our agency
experts, and I'll have our department of legislation reach back
out to you.
Mr. McKinley. Wouldn't you be suspicious? Because we have
had to deal with this pretty severely. We have 52 deaths per
hundred thousand in West Virginia. We are leading the country
on this. Every rehabilitation center I go to asks me that
question: Where did the 28 days come up from? And I have asked
that back under the previous administration, and I am asking it
now under the--can we consider at least maybe a pilot project
that maybe goes for 120 days or 180 days to find out?
Because the impression I am getting under both
administrations is that we are looking for quantity of people
getting treatment, not quality, and if we put someone in a
treatment facility for 120 days, I think the outcome is going
to be far better than 28 days. So I really hope that you can
get back to me on another time. Is that fair to say?
Ms. Verma. That's fair to say, and we'll have our
legislative folks reach out to you. But thank you for your
question.
Mr. McKinley. Thank you. And again, I apologize for the way
you have been treated in this committee so far, OK. Thank you.
I yield back my time.
Ms. DeGette. The gentleman yields back. The Chair now
recognizes the gentleman from Massachusetts, Mr. Kennedy, for 5
minutes.
Mr. Kennedy. Madam Administrator, thank you for being here.
In Arkansas, more than 18,000 Medicaid recipients lost coverage
after CMS approved a work requirement in that State, and in New
Hampshire it was nearly 17,000. Both States, the evidence
suggests that a large number of these people were either
working or eligible for exemptions, but they lost coverage or
would have lost coverage because of red tape.
Now, you might try to tell us that those people found jobs
and employer-sponsored coverage, but a recent study from the
New England Journal of Medicine found that Arkansas' work
requirement increased uninsured rates without increasing
employment. Madam Administrator, are you aware of that study?
Ms. Verma. So, first of all, community engagement----
Mr. Kennedy. Ma'am, yes or no. Are you aware of the study?
I have 5 minutes.
Ms. Verma. I'm sorry. Can you repeat the question?
Mr. Kennedy. Are you aware of the New England Journal of
Medicine study that says that people lost healthcare because of
work requirements in Arizona--or excuse me, in Arkansas?
Ms. Verma. I'm aware of the article.
Mr. Kennedy. OK. So in November of last year, MACPAC, a
nonpartisan agency that makes recommendations on issues
affecting Medicaid, said that low-level reporting in Arkansas
was ``a strong warning that the current process may not be
structured in a way that provides individuals with an
opportunity to succeed with high stakes with beneficiaries who
fail.'' And they called on you to pause disenrollments in order
to make adjustments to the program.
CMS did not pause disenrollments. Instead, you approved the
work requirements in additional States. Why did you approve
work requirements in additional States and not respond to the
concerns of MACPAC?
Ms. Verma. Community engagement requirements are about
improving the lives of people in the Medicaid program----
Mr. Kennedy. Ma'am, can you point to me to one study that
says that a work requirement makes people healthier? One?
Ms. Verma. So I have worked with the Medicaid program for
over 20 years----
Mr. Kennedy. Ma'am, one. I asked Secretary Azar this
question, first question last year. I am certain you were
prepped.
Ms. Verma. There are many studies that talk about how
employment has a positive impact on health outcomes. There are
numerous studies.
Mr. Kennedy. Ma'am, excuse me. No, excuse me. That is--once
again, Secretary Azar, I asked this question to him 8 months
ago. He gave the exact same answer. You guys run healthcare
programs in this country. I am certain you understand the
difference between correlation and causation. Healthier people
might work. Work doesn't necessarily make people healthier. You
are imposing policies on millions of people across this
country. Can you show me one study that says that that is a
good policy?
Ms. Verma. I've spoken to many people on the Medicaid
program----
Mr. Kennedy. I will take that as a no.
Ms. Verma [continuing]. Living in poverty and none of those
individuals want to----
Mr. Kennedy. Reclaiming my time, ma'am, so----
Ms. Verma. [continuing]. Stay where they are. They want to
find a pathway out of poverty.
Mr. Kennedy. I am sure they do. So let's talk about Adrian
McGonigal, who lost his Medicaid coverage in Arkansas because
of the onerous work requirement that you approved. Without
Medicaid, his medication was going to cost him $800, so he did
what anyone would do, he left it at the pharmacy, did his best
to ignore preventable pain and suffering. He failed, the
illness caused him to miss a few days of work, and he got
fired. Your work requirements caused him to lose a job and his
healthcare.
And again, do you consider that a success, yes or no?
Ms. Verma. I think it's premature to draw conclusions about
Arkansas. The program----
Mr. Kennedy. Is it premature to draw the conclusion for Mr.
McGonigal?
Ms. Verma. The program was in effect for 10 months. What I
will say about----
Mr. Kennedy. Eighteen thousand people lost their
healthcare. How many more people have to lose their healthcare
before you can make a determination?
Ms. Verma. Community engagement is about giving people a
pathway out of poverty. People don't want to live in poverty.
Mr. Kennedy. Show me the data that says that--no one wants
to live in poverty. Show me the data that this actually lifts
people out of poverty. One study. One.
Ms. Verma. Again, there are studies that show that when
we're looking at the social determinants of health and we look
at----
Mr. Kennedy. Ma'am.
Ms. Verma [continuing]. Improving somebody's health
status----
Mr. Kennedy. You are not going to spin me----
Ms. Verma [continuing]. Just giving them insurance----
Mr. Kennedy. You are not going to spin me for the 5
minutes.
Ms. Verma [continuing]. Is not going to solve the problem.
Mr. Kennedy. I'm going to reclaim my time, so----
Ms. Verma. We need to address holistic issues.
Mr. Kennedy. Ma'am, are you aware--you talked about the
financial aspects of trying to deliver healthcare in a fiscally
responsible manner. Are you aware of how much Kentucky is
planning on spending to implement its work requirements?
Ms. Verma. I have recused from the Kentucky matter.
Mr. Kennedy. I will answer it for you. It is $190 million
over 2 years. Do you know what per capita annual expenditure on
CHIP in Kentucky is?
Ms. Verma. So States are making investments----
Mr. Kennedy. Two thousand dollars.
Ms. Verma [continuing]. Trying to improve the lives----
Mr. Kennedy. Two thousand dollars.
Ms. Verma [continuing]. Of the people they serve, and those
are one-time implementation costs.
Mr. Kennedy. Ma'am.
Ms. Verma. And that if----
Mr. Kennedy. Reclaiming my time. Are you----
Ms. Verma [continuing]. That are spread over the costs of
the----
Mr. Kennedy. A contract that----
Ms. Verma [continuing]. That relate to the program.
Mr. Kennedy. A contract that was made for your PR
speechwriting and events services was referenced already
earlier in this hearing. Are you aware that one of the line
items was for a confidante of yours named Marcus Barlow, who is
scheduled to receive $425,000 over the life of that contract, 1
year?
Ms. Verma. All of the contracts that we have at CMS are
based on promoting the work of CMS.
Mr. Kennedy. So----
Ms. Verma. When we use contractors, we use them for two
reasons. One reason would be when we require specialized
expertise that we may not have in-house.
Mr. Kennedy. Ma'am, specialized expertise to write
speeches. Are you aware that for that same cost 2,000 kids
could have--excuse me, 200 kids--in CHIP, eligible for CHIP in
Kentucky, could have kept their healthcare?
Ms. Verma. The contracts that we have----
Mr. Kennedy. What is a better use of those healthcare
dollars, of U.S. taxpayer dollars: to employ an additional
communications person underneath CMS that already has dozens,
if not hundreds, or 200 more kids that could get access to
healthcare? What is a better stewardship of those taxpayer
dollars?
Ms. Verma. The use of our contracts are to promote the
programs that we have in place. We use contractors----
Mr. Kennedy. At the expense of those 200 kids?
Ms. Verma. Those contracts are consistent with what
previous administrations have done.
Mr. Kennedy. At the expense of those 200 children.
Ms. Verma. Those contracts that we have in place are
consistent with how the agency has used resources in the past,
and they're focused on promoting the work. One of the things
that we want to do is make sure that people understand----
Ms. DeGette. The gentleman's time has expired.
Mr. Kennedy. That is a shame.
Ms. DeGette. The Chair recognizes the gentleman from
Virginia for 5 minutes.
Mr. Griffith. Thank you very much.
Did you wish to finish your answer?
Ms. Verma. Yes. So what I was trying to say is that the
contracts that we have in place are about promoting the work of
the agency. One of the things that I wanted to do when we came
to CMS is make sure that the American people understand the
things that we're doing. We've had a historic number of
initiatives, 16 initiatives, and it's important that the
American people understand that. We did not have that expertise
in-house at the time.
And the other thing that we use contractors are for is when
we have something that we cannot do in-house, so that's one
reason, or we need some short-term help. My job at the agency
is to set the vision and set the agenda, and it's up to other
staff members to determine whether that work can be done in-
house or whether we need to hire contractors.
Mr. Griffith. And in relationship to CHIP, wouldn't you
agree that the Championing Healthy Kids Act was a major step
forward?
Ms. Verma. It absolutely was. I think it's very important
that children have access to healthcare coverage, very
important to their development.
Mr. Griffith. And would you be surprised to learn that a
number of members of this committee voted no, particularly
those on the other side of the aisle?
Ms. Verma. That would be very concerning.
Mr. Griffith. I understand. Also, I find it interesting,
just cleaning up some stuff here, that CBO estimates that 2.6
million more people have employer-funded insurance today than
before President Trump took office. Were you aware of that?
Ms. Verma. Yes. I think that our agency's success and the
success of the administration is clear. Premiums are lower not
only in the exchanges but also in Medicare. There are more
choices for people in Medicare and in the exchanges, more than
what we had when we came into office.
Mr. Griffith. Now, we have heard a lot today about
sabotage, and my friend, the gentleman from West Virginia, Mr.
McKinley, talked about the fact that sabotage has been used a
lot. But I would have to say to my colleagues on the other side
of the aisle that, when you write a bill such as Obamacare and
you put in there 3,033 times the words ``the Secretary''
appears and 974 times the words ``the Secretary shall'' appear.
And off the top of his head, Dr. Burgess indicated there were
about 262 times that you, if you kept going out, you know,
``shall determine,'' ``the Secretary shall determine'' appear,
roughly, and we will have to double check that one, but that is
off the top of his head.
Wouldn't you think it would be unfair to say that the law
had been sabotaged when the Congress--now, remember, that was a
bill passed, Obamacare passed specifically and only by
Democrats. No Republicans in the House voted for it. So, if it
was sabotaged, it was sabotaged because they gave too much
power to the administrative branch of government, and today
they find themselves with an administrative branch of
government that has a different philosophical outlook and,
therefore, if it were in fact sabotaged, it was sabotaged at
its initiation in the passage of that bill. Would you agree
with me on that?
Ms. Verma. I would agree and the results speaks for
themselves. Premiums are lower. When I got into my role,
premiums were going up, a hundred percent in some cases, some
200 percent in some cases. This is for the first time that
we've actually seen premiums go down. They went down last year.
They're going down again. We've put out over 12 reinsurance
waivers, and in some cases you've seen double-digit decreases,
30 percent.
So for all the work that we're doing, I don't know how we
measure that, but to me that looks like success.
Mr. Griffith. Yes, ma'am. And now, so let's get to
something else I need to talk about. Earlier this year it came
to my attention that CMS planned to include noninvasive
ventilators in Medicare's competitive acquisition program for
durable medical equipment. In June, Mr. Welch and I led a
letter signed by 180 of our colleagues expressing concern about
that decision.
I support the goal of ensuring financial responsibility in
healthcare, but I am not convinced that this method is
appropriate in every situation. Until we know that access to a
critical piece of medical equipment won't be compromised, I
don't think we should be making monumental changes to the
acquisition process. And I just got your letter--it arrived
late yesterday afternoon--in response to that letter, where you
said we are not going to do it on invasive.
But here is the problem I have. I have a rural district, as
does my friend Mr. Welch. And what happens is, is that if you
go to this cost-only issue, in those rural areas you are going
to make somebody drive 45 minutes, an hour. I remember talking
to one of my suppliers about a case where the lady lived on top
of one of the two highest peaks in Virginia, and he took her
oxygen up there to her and made sure that she had what she
needed for her ventilator supplies, noninvasive.
She is not coming down the mountain, particularly not in
the wintertime, to get what she needs if now the low-cost
supplier is only located in the town. And if it becomes a point
where they have to get to Bristol, you are talking about even
more time. But just to get down the mountain to Marion, it is
going to take a lot of time. So I would ask you all to really
take a look at that because I am afraid that in the rural
districts our folks are not going to get served. I yield back.
Ms. DeGette. The gentleman's time has expired. The Chair
now recognizes the gentleman from California, Mr. Ruiz, for 5
minutes.
Mr. Ruiz. Thank you. This administration has made clear
from day one that they will not protect people with preexisting
conditions or protect access to affordable healthcare for
Americans. They continue to repeal the ACA first through
legislation, and when that failed through the courts. And in
lieu of complete repeal, they have done everything they can to
chip away at the protections that it provides.
Repealing the protections harms patients but helps
insurance companies make greater profits. It gives them power
to deny and delay care for people who really need it. And as a
physician I took an oath to do no harm, and trying to take
affordable coverage away from millions of Americans flies in
the face of that oath. I practiced medicine before the passage
of the Affordable Care Act, and I saw what that meant for
patients.
So let me tell you a little bit about what that was like.
In fact, even when I was in medical school, during my medical
school graduation at Harvard Medical School, my whole family--I
have a big family, and they came from everywhere. And we were
in my tiny little apartment and we were getting ready for my
ceremony, and my little sister curls over in excruciating
abdominal and flank pain, excruciating, shaking.
And we were so very concerned, but she refused to go to the
Emergency Department. It wasn't necessarily because she was
going to miss my graduation, she didn't want to be a burden to
us for that, but primarily she didn't have health insurance and
she couldn't afford it and she was so afraid, so she just
endured it. And that is what families do throughout our
country, they endure this pain. Well, she was 22. Now, she
could have been on her parents' health insurance.
The second story is like a man 55 years old from Palm
Springs with HIV positive status. Before the Affordable Care
Act, infections after infections, life-threatening, very
concerned he wasn't going to live past, you know, 58 or
something. And now, because of the Medicaid expansion, he is
happy. He is living well. He finally can get the care and the
medications and everything that he can have, and he is living
that life that he has always wanted to.
It is like that young mother of two who came into my
Emergency Department with the chief symptom of ``a lump in my
breast.'' And I am thinking, a lump in your breast? Why are you
coming during the holidays for a lump in your breast? She
didn't have any primary care. She didn't have insurance. She
knew it was growing, it was the size of a lemon. It was
irregular in form, it was painless. Her sister forced her
because they knew what they were afraid of. And, sure enough,
it was most likely cancer. I was able to connect her with post-
Emergency Department care.
But, because of the Affordable Care Act, that preventive
mammogram is now covered, and that she couldn't afford it and
now she potentially had cancer metastasized to her body. That
is why we are angry. It is for those patients that we are
standing up. It is for the American people who are today scared
that we are going to go back to a time where they are going to
be denied and delayed, that they are going to endure pain, that
they are going to potentially lose their life and leave their
children behind, that they are going to suffer infections, and
that is why we are pressing you and this administrations for
those questions.
Because this administration is encouraging the Supreme
Court to strike down the ACA in its entirety, all of it. There
is no defense in court to protect people with preexisting
condition. There is no defense in court for the young people to
stay on their parents' health insurance. There is no defense of
the Medicaid expansion. There is no defense of protections for
preventive care that help my constituents, my patients, and my
family.
There is no defense for the American people in those
protections for them. And to make matters worse, you have no
plan. You can't produce a document. You can't give us a detail.
You are skirting the issues, and all we are getting is only
spin and talking points. The American people deserve better. I
yield back my time.
Ms. DeGette. The gentleman yields back. The Chair now
recognizes the gentlelady from Indiana, Mrs. Brooks, for 5
minutes.
Mrs. Brooks. Thank you. And thank you, Administrator Verma,
for being here today.
Actually, the stories that you have heard from my
colleagues, I assume that in your role for the last 3 years,
you have mentioned that you have been having roundtable
discussions. And that wasn't what I was originally going to ask
you, and I do want to save a little time for what I want to
talk about with you. But can you share very briefly, how you do
stay connected with the patients and the people you are trying
to serve?
Ms. Verma. Well, I appreciate that. We've done a national
listening tour, and we talk to people all over the Nation.
Mrs. Brooks. People who--can you share who these people----
Ms. Verma. People who are having trouble----
Mrs. Brooks. Yes, the type of people you talk to?
Ms. Verma [continuing]. Affording Obamacare. And so, in the
examples that were used previously, I'm scared for those people
too, because if they don't have a subsidy they often cannot
afford health insurance under Obamacare. Obamacare structure is
so expensive that the middle class can't afford health
insurance, and that's why we're seeing increases in the number
of uninsured, because premiums have gone up a hundred percent,
200 percent.
And while this administration has stabilized the market--
premiums are going down--they are still too expensive, and if
you do not have a subsidy and if you have a preexisting
condition, you do not have protections today. And that's why
this administration is trying to advance efforts to try to make
sure that every American has access to affordable coverage.
That is not the case today.
Mrs. Brooks. Thank you. I want to pivot and focus on, you
talked about the role of technology and innovation in the
healthcare system. Medical error is the third-leading cause of
death in the United States, responsible for claiming over
400,000 lives, and millions of dollars are wasted on
duplicative and unnecessary tests and procedures. We know that
patients want their up-to-date medical information at their
fingertips.
Congresswoman Clarke, a colleague of mine across the aisle,
and I introduced the Mobile Health Record Act, and it directs
CMS to do more to promote the use of secure medical records
approved by CMS through the Blue Button 2.0 program. The
proposed CMS Interoperability and Patient Access rule is to be
published before the end of the year, requiring Medicare
Advantage plans first and Medicaid plans next, to offer open
APIs for their plan enrollees to access their medical data with
their mobile application of choice.
And you mentioned, more and more patients are tech-savvy
and want this type of access, but I remain concerned about the
lack of public promotion or awareness of the CMS Blue Button
program and its Medicare-approved apps for the 60 million
Medicare beneficiaries. And, in fact, a recent survey showed
that only three out of a hundred Medicare Advantage members are
even familiar that the Blue Button 2.0 program exists.
Knowing how important this is, what more can be done to
reach new enrollees? It is very complicated to get through your
websites and process to find the Blue Button, and yet people
want to have their medical records in their hands. So can you
talk to us about what your plans are to improve access to our
own medical records?
Ms. Verma. I appreciate the question, and I agree with you
that we can do more to make sure that people understand what's
available. The issue of patient records--and if you'll indulge
me for a second, I'll tell you a story, because I think it sort
of sums up the issue of patient access.
My family was traveling, they were headed home. I was
headed back to DC when my husband had a cardiac event. He had a
major seizure. My daughter called me and handed the phone to
the paramedics, and they said, ``Ma'am, your husband's not
breathing, and we need to understand his health history. Is
there anything in his health history?''
And at that moment----
Mrs. Brooks. How long ago was this?
Ms. Verma. This was about 2 years ago, in 2017. And so, at
that time, you know, obviously I'm in a panic, but I did not
have that information. My family didn't have that information,
and my husband was in no condition to tell us about his health
history. And I scrambled for about 2 hours in the time that it
took me to get to my kids and get to my husband to try to find
this information.
In the end, the hospital had to do a number of tests
because they couldn't figure out what was wrong. Luckily, he's
OK and he survived something that maybe less than 1 percent of
people survive, so he was very lucky. But when I left the
hospital, I asked the staff there, can I have a copy of all the
tests that you performed, so I had a complete medical record to
give back to his doctors in Indiana, and unfortunately all they
could give me was a CD-ROM.
So after our Federal Government spent $36 billion on
electronic health records, all I got was a CD-ROM, which really
only had a record of one test, and so that really spoke to me
of the issues. Patients need to have access to their complete
medical records so that we can understand the issues that we
face.
Mrs. Brooks. Can I interrupt? Are you going to dedicate
more people to this, and how are you going to fix this?
Ms. Verma. This is one of our main priorities. We have
several rules. One is about making sure insurers are providing
claims data to patients. We are giving incentive payments to
physicians to make sure that they're providing data to their
patients. Hospitals are facing penalties.
Ms. DeGette. The gentlelady's time has expired. The Chair
now recognizes the gentlelady from New Hampshire, Ms. Kuster,
for 5 minutes.
Ms. Kuster. Thank you. And thank you, Ms. Verma, for being
with us today.
A quick yes-or-no question before we start. I understand,
yesterday, Secretary Azar said that the reason he is not
concerned about the court decision ending the ACA overnight is
that he is relying upon an appeal to the Supreme Court. Is that
your position? Is that why you don't have a plan to tell us
today?
Ms. Verma. We have planned for a number of different
scenarios.
Ms. Kuster. But are you expecting----
Ms. Verma. I think what the Secretary is speaking to is
that this is going to take some time for the courts to resolve,
but we have planned for a variety of different scenarios.
Ms. Kuster. Including an appeal to the Supreme Court?
Ms. Verma. Correct.
Ms. Kuster. So--because I am a little confused today by
your testimony and particularly by the testimony of our
colleagues. I have been in Congress for 7 years. I voted 55
times not to repeal the Affordable Care Act because our
colleagues were so persistent about week after week, month
after month voting over and over again to repeal the Affordable
Care Act in its entirety. And now this administration is in
court asking to repeal the Affordable Care Act in its entirety.
And yet, you sit here today singing the praises of the
Affordable Care Act and how proud you are of your work to bring
down the rates, but at the same time you are cutting access for
400,000 children. That was your testimony this morning.
So I just want to move to a particularly important part for
my constituents, which is the issue of preexisting conditions.
And you will recall that, before the Affordable Care Act,
Americans could be denied their health insurance coverage if
they had any kind of a preexisting condition. I think about it
in my family. I will just start at the beginning of the
alphabet: asthma, allergies, Alzheimer's, cancer, diabetes, the
list goes on and on. And, in fact, over 50 percent of Americans
have a deniable condition.
In New Hampshire, that is 54 percent of our citizens have a
deniable condition, and yet your administration, in fact your
own actions with the short-term limited duration health plans--
by the way, a classic Washington, DC doublespeak, short-term
limited duration health plans--have threatened families with
preexisting conditions. And, in fact, you have encouraged
States to promote junk plans through their waivers in order to
circumvent essential health benefits and protections for
preexisting conditions.
I was very proud to lead bipartisan legislation. It passed
the House, Protecting Americans with Preexisting Conditions,
last May, and it will ensure that people with preexisting
conditions are covered. But let me ask you, do you believe, Ms.
Verma, that allowing individuals to once again be discriminated
against or have their coverage declined due to preexisting
conditions is moving America in the right direction for their
healthcare? Just yes or no.
Ms. Verma. None of the actions that we have taken do
anything to undermine the protections for people with
preexisting conditions.
Ms. Kuster. Well, encouraging junk plans that do not cover
Americans with preexisting--we heard the testimony right here.
We had families right in front of us, and they had no idea.
There was no requirement that they be warned of that, and
instead of 3 months, these were a year and they could be re-
upped multiple times. So I think your testimony is not actually
truthful to us today, and I regret that.
According to a 2019 study by the Kaiser Family Foundation,
half of Americans, as I mentioned, have a declinable condition.
Did your agency conduct an analysis to evaluate the effects of
the implementation of your guidance on these families and their
access to affordable health insurance? Yes or no.
Ms. Verma. I'm sorry. Which guidance are you referring to?
Ms. Kuster. The guidance that you provided about the
waivers and the junk health plans. Did you analyze the impact
on American families that had preexisting conditions? Yes or
no.
Ms. Verma. So in the issue of the 1332 guidance that we put
out for States, I can tell you that States have had an
enormously difficult time----
Ms. Kuster. Just a quick question.
Ms. Verma [continuing]. Experiencing the double-digit
rate----
Ms. Kuster. Did you----
Ms. Verma [continuing]. Increases. And we wanted to----
Ms. Kuster [continuing]. Analyze what would happen to
families with preexisting conditions? Yes or no.
Ms. Verma. The way the guidelines work is, we give
basically direction to States about how they can develop plans
to make health insurance more----
Ms. Kuster. I am asking if your office analyzed the impact
of your guidance. Yes or no. This is not difficult.
Ms. Verma. So we have to impact--we would have to review
the proposals. And so for every proposal----
Ms. Kuster. And can you provide that to this committee,
your analysis?
Ms. Verma. Every proposal that comes in under 1332 is
analyzed around the four guardrails around comprehensive
coverage.
Ms. Kuster. And could you provide that analysis to this
committee? My time is up. Yes or no.
Ms. Verma. So every single proposal that comes in----
Ms. Kuster. Yes or no, you'll provide that analysis to this
committee?
Ms. DeGette. The gentlelady's time has expired.
Ms. Kuster. My time is up.
Ms. DeGette. The Chair now recognizes the gentleman from
South Carolina, Mr. Duncan, for 5 minutes.
Mr. Duncan. Thank you, Madam Chairman.
Administrator Verma, I will let you finish answering her
question if you need to.
Ms. Verma. Sure. So let me start with short-term limited
duration plans. These are plans that have been available before
Obamacare started and during Obamacare. They used to just be
available for 3 months, and we extended the period of time. We
also made sure and we strengthened these protections, which
were not in place under the previous administration, to make
sure that people understood what type of plan that they were
buying and what the limitations were of these plans.
But there are so many Americans today that cannot afford
coverage under Obamacare when rates have gone up a hundred to
200 percent, and I gave you some examples of a couple in
Nebraska. They are 55 years old, and the premiums that they
would have to pay are anywhere between a third to half of their
income. Short-term limited duration plans provide a lifeline.
They can provide coverage at rates that are perhaps 60 percent
lower than what they could find under Obamacare, so it provides
an alternative.
There's many people that are in between jobs that cannot
afford Obamacare, and this is an alternative. And our
administration has done everything that we can to ensure that
there are protections in place and that those plans clearly
articulate the limitations of what they may or may not cover.
Mr. Duncan. Yes. Thank you for that. I apologize for how
some of my colleagues have treated you today.
Let me say I appreciate the multiple conversations we have
had regarding some of the nursing home issues occurring across
the Southeast Region. We have touched on topics including
inconsistencies and civil monetary penalties, citations given
among the regions, and how facilities in Region 4 have been
especially hit. We have also touched on the important need for
specific guidance to be provided for abuse reporting rules.
Another thing I would appreciate you looking further into
is the red consumer alert icon that could be placed next to
nursing homes that have been cited for incidents of abuse and
the Nursing Home Compare website. I understand this initiative
goes into effect today. However, I feel CMS needs to fully
solve the CMP and abuse reporting issues, first, before we go
negatively labeling facilities online. If facilities in the
Southeast Region don't get relief soon, we are going to be in a
tight spot.
So can you and your staff please comment or at least commit
to revisiting the issue of consumer alert icon being
implemented?
Ms. Verma. Well, we've put out a five-part strategy on
strengthening oversight, enhancing enforcement, increasing
transparency, improving quality, and putting patients over
paperwork. One of the things that we've done is we have
clarified immediate jeopardy guidelines. And I agree with you
that there has been inconsistency in how CMS and State agencies
have implemented the guidance, and so that's why we've created
a new performance standard system so that we can monitor what's
going on in the local level to ensure that we have consistency
in how we are clarifying immediate jeopardy in cases of abuse
and neglect.
In terms of the icon, there's about maybe 5 percent of
nursing homes that will be impacted by this, and it only alerts
those in which we've had cases of abuse and neglect. And, you
know, if there's other types of issues that have come up,
they're sort of, I would say, not high-level areas of abuse and
neglect, in those areas we only use the icon if they have been
repeat offenders.
So this isn't really going to impact very many nursing
homes. There are many nursing homes that provide high-quality
care, but there are some out there--and we think it's important
to make sure that the American people have the information that
they need to make the decisions that work best for them.
Mr. Duncan. In the essence of time, we will move on. We
will be watching some of the reforms and how they impact the
nursing home facilities.
I want to touch base on one other thing, and that is the
exchange program integrity Section 1303 in the Affordable Care
Act. We have asked--we talked yesterday about this. You say
that the ruling finalization is supposed to be in HHS's hands
now. Open enrollment period begins November 1st, and I think
clarification on this is important. We sent a letter July 1, me
and many, many of my colleagues signed this, asking for
Secretary Azar to approve that.
I want to submit that, if we can, to the record, Madam
Chair. And also want to urge my colleagues, I am going to send
another letter today, if you would like to sign on to that, on
the 1303 urging fast implementation.
Ms. DeGette. Without objection, the letter will be entered.
[The information appears at the conclusion of the hearing.]
Mr. Duncan. I would also like to add a letter from some of
the care providers that have urged us to take action as well,
for the record.
Ms. DeGette. We will review that letter. I haven't seen
that letter.
Mr. Duncan. Thank you. It is important that this rule get
finalized, and it was proposed November of 2018. That is almost
a year later, and it still hasn't been. Can you speak to the
work CMS has done to help finalize this rule and what the
current status is? We know it is in Azar's hands, but if you
would like to touch base on that in 10 seconds.
Ms. Verma. We share your commitment to getting that rule
finalized, and we'll be doing everything that we can to bring
that to fruition.
Mr. Duncan. OK. If any colleagues want to sign on to that
letter to Secretary Azar today by close of business, you can
contact my office. I yield back.
Ms. DeGette. The Chair will admit the second letter that
the gentleman referenced.
[The information appears at the conclusion of the hearing.]
Ms. DeGette. The Chair now recognizes the gentlelady from
Florida, Ms. Castor, for 5 minutes.
Ms. Castor. Thank you, Madam Chair. And thank you,
Administrator Verma, for being here today.
The Trump administration has made numerous policy changes
that increase the costs on families across this country,
increase health insurance premiums, and erode coverage for
preexisting conditions, preexisting conditions like cancer and
diabetes. We had all hoped that this fight was over, but we are
going to continue to have to work to make sure that families
who have preexisting conditions get their coverage.
You stated earlier in your testimony that the Trump
administration policies have stabilized costs. There is no
evidence of that. A recent study by the Kaiser Family
Foundation estimates that 2019 premiums are 16 percent higher
than they otherwise would be due to the Trump administration's
actions. And a report out of your own agency has established
that the various sabotage policies of the Affordable Care Act
has increased costs on families who are not eligible for tax
credits.
And one of the most egregious policies that has increased
costs is the expansion of the junk health insurance plans, the
short-term limited duration plans, because what has happened,
after the Trump administration and the GOP failed to repeal the
Affordable Care Act and dramatically cut health services under
Medicaid, they turned to a very insidious plan to cut outreach
and enrollment, weaken the health insurance pool by eliminating
navigators, and then marketing, allowing these junk insurance
plans to roll out, to the detriment of the families we
represent.
These junk insurance plans do not have to cover preexisting
conditions. They don't have to cover hospital ER care or
prescriptions drugs. They don't have to cover mental health
services. And when Secretary Azar was here, Madam
Administrator, we asked him, I asked him specifically, ``Are
you aware that these plans can exclude coverage for preexisting
conditions or decline to offer coverage to individuals with
preexisting conditions, yes or no?'' And he responded, ``Yes,
that's correct.''
Do you disagree with him that these junk insurance plans
don't have to cover preexisting conditions, or you agree with
Secretary Azar?
Ms. Verma. Short-term limited duration plans provide more
flexibility. And under our administration, premiums----
Ms. Castor. Well, by flexibility are you saying--you agree,
then, they don't have to cover preexisting conditions. That
is--see, this is very dangerous because we are about to enter
into an open enrollment period, right, the open enrollment
under the Affordable Care Act dates are--what date?
Ms. Verma. They start November 1st.
Ms. Castor. And run through?
Ms. Verma. They go through December 15th.
Ms. Castor. OK, so be careful, consumers, families across
the country. If you go online and you type in ``I am looking,
shopping for health insurance'' sometimes what will come up
will be one of these junk insurance plans. The Federal Trade
Commission has already had to act and shut down some of these
fly-by-night health insurers, calling it a bait-and-switch
scheme.
So when you are shopping for your health insurance, be
careful. A lot of these companies are going to market a plan
that says, oh yes, we will cover you, we will cover your
preexisting condition, and then they find it is not covered. In
fact, the nonpartisan Congressional Budget Office confirmed in
a report that short-term plans have large coverage gaps that
expose consumers to catastrophic costs, especially for folks
with preexisting conditions. For example, a woman who enrolled
in a short-term plan and was then diagnosed with breast cancer
could face between $41,000 and $111,000 in out-of-pocket costs.
That is from the CBO and the American Cancer Society Action
Network.
Another one of the insidious sabotage efforts has been to
our independent navigators across the country. And there is a
lot of misinformation coming out that, oh, navigators aren't
effective. Well, if you go to the Kaiser Family Foundation
report and the Government Accountability Office report from the
past few months, they said, wow, HHS is pedaling false
information. These navigators are--brokers are fine, but
navigators do not have allegiance to an insurance company, they
have an allegiance to the consumer, often help them sort
through all of their affordable options.
So it is really unwise to eliminate navigators on one hand,
market junk plans, cut outreach and enrollment--all of these
things undermine a health insurance pool that helps keep costs
down for families.
Ms. DeGette. The gentlelady's time has expired.
Ms. Castor. Thank you very much. I yield back my time.
Ms. DeGette. The Chair now recognizes the ranking member of
the full committee, Mr. Walden from Oregon, for 5 minutes.
Mr. Walden. Good morning, Madam Chair. And, Ms. Verma,
thank you again for being here. We appreciate your leadership
at the agency and your sitting through these discussions.
I want to talk about the navigators, because in the CMS
report that I believe is from 2016, which is before the Trump
administration, for plan year 2017, navigators received $62.5
million in Federal grants, they enrolled 81,426 individuals,
which, if I understand that right, equates to $767 per person
is the math if you divide the total number enrolled versus the
total amount spent. Now also, according to CMS from the Obama
administration data, 17 navigators enrolled less than a hundred
people each at an average cost of $5,000 per enrollee, and 78
percent of the navigators failed to achieve their enrollment
goals.
So this is from the CMS information that is from 2016 for
plan year 2017, and when did you become administrator?
Ms. Verma. In March 2017.
Mr. Walden. Yes. So in 2017, then, CMS announced that it
would start awarding funding to navigators based on their
ability to meet their enrollment goals. That sounds like pretty
standard business practice.
Ms. Verma. That's right. We have a duty to taxpayers to
make sure that our programs are cost effective.
Mr. Walden. And so, as a result, CMS reduced the funding
for the program by 10 million for 39 organizations in 2018.
Why? Why did you do that?
Ms. Verma. We did that because the navigator program was
not producing the types of results that we would expect to see.
My goal is to make sure that consumers using HealthCare.gov or
our call centers have a very smooth experience, and we felt
like there were more different ways. When a program is new, it
does require a lot of intensive investment in terms of outreach
and enrollment.
Mr. Walden. Sure.
Ms. Verma. But looking at the Affordable Care Act, it had
been in place, and we were looking, reviewing the types of
investments that have been made. We had seen from the previous
administration that they had actually doubled their advertising
budget to a hundred million dollars, but actually enrollment
went down, so we knew that those types of things weren't
effective.
And the same thing with the navigator program. When we did
the math, it just didn't add up when you are spending $5,000
per person. So what we tried to do is invest in more cost-
effective ways, digital ads, more of those types of things, and
I think our results have been effective. We had a 90 percent
customer satisfaction rate for people that used our call
centers.
We haven't seen the dire predictions in terms of enrollment
going down. We've had minor fluctuations, which I think can be
attributable to the Trump economy where things are move--are so
good that people don't necessarily----
Mr. Walden. Well, let me ask you that. And I am sorry to
interrupt you, but on that very point, aren't--how many more
people are now covered by private insurance as a result of the
strong economy?
Ms. Verma. Well, because of the strong economy, what we're
seeing is that people aren't relying on public programs as
much. We are seeing, however, some of the individuals, though,
that aren't subsidized, that they're having trouble affording
health insurance and that the increase in the number of
uninsured is actually for people that are 300 and 400 percent
of the poverty level.
And so, what that shows us is that they can't afford health
insurance premiums because of the way Obamacare is structured,
and so people that are subsidized, we're seeing their
enrollment go up, but it's the unsubsidized population where
we're seeing problems. We've seen a 40 percent decrease.
Mr. Walden. So this is kind of the middle class----
Ms. Verma. That's right.
Mr. Walden [continuing]. That is caught right there. Not
getting a subsidy, can't afford the health insurance they are
stuck with, and you are trying to give options and have States
involved. My State has come to you and gotten relief from
certain Federal requirements, right?
Ms. Verma. That's correct. We've been doing reinsurance
waivers, and I think the short-term limited duration plans and
association plans, those are efforts of the administration to
give people alternatives because we know the middle class
cannot afford expensive Obamacare. So we're trying to provide
more choices and let the American people decide what benefit
plan is going to work best for them, not a one-size-fits-all
government approach, which is expensive. We think Americans
should make those decisions themselves.
Mr. Walden. When we had a big debate on the floor on some
healthcare issues, and a number of my friends on the other side
of the aisle had amendments directing the navigators do a whole
bunch of things--reach out to rural areas--and I raised the
issue then, and I think we followed up with a letter to you
recently. That told me the system is broken with the
navigators, because they were having to have amendments
directing the navigators to do all these different things. And
so, is that system broken?
Ms. Verma. Yes. And I also think that, you know, we look
at--we do open enrollment for the Medicare program every year,
and what we do there is we use a system of volunteers to help
individuals.
Mr. Walden. Are their navigators paid from, like, Medicare
Part D or Medicare?
Ms. Verma. No. We use a system----
Mr. Walden. All right.
Ms. Verma [continuing]. Something we called our SHIP
volunteers, and they do an incredible job of helping seniors
through the open enrollment process. So I think there's better
ways and more cost-effective ways.
Mr. Walden. Thank you. My time has expired. Thank you,
Madam Chair.
Ms. DeGette. Thank you so much. The Chair now recognizes
the gentlelady from New York, Ms. Clarke, for 5 minutes.
Ms. Clarke. I thank you, Madam Chair, and I thank our
ranking member.
Administrator Verma, Hubert Humphrey, he was the namesake
of the building that you work in, said, ``The moral test of
government is how the government treats those who are in the
dawn of life, the children.'' This quote is even inscribed on
the wall as you walk through the front door of HHS. On your
watch, it is safe to say that this administration has failed
that moral test.
This administration inherited historically low uninsured
rates among children, but thanks to this administration's
sabotage and mismanagement of healthcare, those rates have gone
up from 3.6 million uninsured in 2016 to 4.3 million uninsured
children in 2018. You have said you want to preserve Medicaid
for those who truly need it. Are low-income children among
those who truly need Medicaid? This is a yes-or-no question.
Ms. Verma. As a mom--I have two children--I think having
health insurance for children is extremely important to their
development.
Ms. Clarke. Very well. So the New York Times has reported
yesterday that, since 2017, more than a million children have
lost coverage in Medicaid and CHIP. Further, the Census Bureau
reported that on your watch the children's uninsured rate
increased to 5.5 percent, largely because of the deadline in
coverage under Medicaid and CHIP.
Administrator Verma, do you agree with the findings of your
administration's own Census Bureau? Yes or no.
Ms. Verma. There's a couple of--there's two separate issues
here.
Ms. Clarke. Yes or no. Yes or no. Do you agree? Have you--
--
Ms. Verma. It's not a yes-or-no question.
Ms. Clarke. It is a yes-or-no question. Either you agree
with what the Census has presented to you or you don't.
Ms. Verma. I believe that the Census data is accurate.
Ms. Clarke. Do you agree with it? Yes--it is accurate, so
that is a yes. You have previously claimed that the children
who lost Medicaid have transitioned into private coverage, but
if that were true, we would see an increase in the enrollment
in private coverage. However, your own Census Bureau says that
that is not the case, that there has been no increase in the
number of children covered under private insurance.
Administrator Verma, can you explain why the rates of
children enrolled in Medicaid CHIP are declining while private
insurance coverage has remained flat?
Ms. Verma. So, if we look at the number of uninsured
children, which I'm deeply concerned about, the biggest drop is
for families that are earning above 400 percent of the poverty
level. And so what's happening is, under the Trump economy, the
economy is the best that we've had in 50 years, unemployment is
down.
Ms. Clarke. I don't want to hear your talking points.
Ms. Verma. There's less people living in poverty.
Ms. Clarke. Reclaiming my time. The New York Times story
talked about a little boy in Texas named Elijah whose family
didn't know that he had been kicked off Medicaid until he was
admitted to intensive care for a respiratory virus. Texas has
the highest number of uninsured children in the country and
conducts more frequent eligibility checks than any other State.
Data shows that, of the 50,000 children in Texas kicked off
Medicaid, more than half regained their coverage within 12
months, which means these children were dropped erroneously.
In Tennessee, tens of thousands of children lost coverage
because of late or incomplete paperwork. Until recently,
Tennessee used an application that could be up to 47 pages long
that one Medicaid expert called ``daunting.''
Administrator Verma, we all agree that the program
integrity is a critical part of any Federal program, but would
you agree that the program integrity requirement should not be
weaponized to kick children off of Medicaid? That is a yes or
no.
Ms. Verma. I think it's important that children have
coverage, first of all. In terms of program integrity,
unfortunately, we're seeing that there are major problems in
Medicaid eligibility. We're hearing cases all the time. I can
tell you I saw data yesterday which is concerning.
Ms. Clarke. I understand your concern. But you should be
far more concerned about the decline or the increase in the
numbers of children who are uninsured. You talked about being a
parent and what you want for your children. What about low-
income children across this Nation? That is your
responsibility. So you can say you want to preserve Medicaid
for those who truly need it, but on your watch over a million
children have lost Medicaid and CHIP coverage and the
children's uninsured rate has reversed years of gains. The
numbers don't lie and are clearly going in the wrong direction.
You have failed the most vulnerable amongst us. You have failed
the American people.
With that, Madam Chair, I yield back.
Ms. DeGette. The Chair now recognizes the gentleman from
New York, Mr. Tonko, for 5 minutes.
Mr. Tonko. Thank you, Madam Chair.
Administrator Verma, CMS has promoted and expanded the
availability of short-term limited duration insurance plans
that are not required to comply with the comprehensive consumer
protections of the Affordable Care Act. These junk plans
undermine protections for people with preexisting conditions,
increase costs, and leave American families with less financial
protection and more exposure to fraud.
Now I want to follow up on Representative Castor's
questioning. Administrator Verma, isn't it true that these
plans are allowed to exclude coverage for preexisting
conditions?
Ms. Verma. Short-term limited duration plans provide----
Mr. Tonko. Yes or no. Yes or no.
Ms. Verma [continuing]. An alternative. There's a----
Mr. Tonko. Yes or----
Ms. Verma. It depends on the plan.
Mr. Tonko. Yes or no.
Ms. Verma. It depends on the plan.
Mr. Tonko. Isn't it true that these plans are allowed to
exclude coverage, are allowed to exclude coverage? Yes or no.
Ms. Verma. Short-term limited duration plans have more
flexibilities than----
Mr. Tonko. I am asking for a yes or no. I have 5 minutes,
so I want to get----
Ms. Verma. It depends on the plan. There are different
types of short-term limited duration plans.
Mr. Tonko. I am asking if these plans are allowed to
exclude coverage. That is a yes-or-no question.
Ms. Verma. Short-term limited duration plans have the
flexibility around benefit design.
Mr. Tonko. So it is a yes.
Ms. Verma. But it depends on how that plan is structured.
Mr. Tonko. But they are allowed to exclude coverage?
Ms. Verma. Not all of the plans will do that. It depends on
the plan.
Mr. Tonko. Are they allowed to?
Ms. Verma. And what we have done is to ensure----
Mr. Tonko. You are not answering the question, ma'am.
Ms. Verma [continuing]. That there are the appropriate
protections in place for consumers so they understand the type
of coverage they are buying.
Mr. Tonko. Ma'am, I mean, you are eating up the clock. I am
asking if they are allowed to exclude coverage for preexisting
conditions.
Ms. Verma. They have flexibility around benefit design.
Mr. Tonko. So that is--I believe that is a yes answer.
Administrator Verma, isn't it true also that people on these
plans can be charged higher premiums without limit based on
their health status, gender, age, and other factors? Yes or no.
Ms. Verma. The CBO said that the short-term limited
duration plans could be 60 percent lower than the Affordable
Care Act plans.
Mr. Tonko. Yes or no, can they be charged higher premiums
without limit based on their health status, gender, age, and
other factors?
Ms. Verma. They have the flexibility. They do not have to
comply----
Mr. Tonko. They have the flexibility, so that is a yes.
Ms. Verma [continuing]. With the Obamacare plans.
Mr. Tonko. Thank----
Ms. Verma. But that's why they're priced lower.
Mr. Tonko. I don't want to use any more time.
In addition to excluding coverage of preexisting
conditions, charging people more based on their health status,
I am concerned by the failure of these plans to cover basic
healthcare services.
Administrator Verma, isn't it true that junk plans can
refuse to cover essential health benefits like hospitalization,
maternity care, prescription drugs, mental healthcare, and
preventive care? Yes or no.
Ms. Verma. You know, I was talking to a family the other
day that they lost----
Mr. Tonko. Well, yes or no. It is OK that you had that----
Ms. Verma [continuing]. Their health insurance. They lost
their job.
Mr. Tonko. Ma'am. Ma'am, yes or no. It is my time. Is it
true that these can refuse, these plans can refuse to cover
those essential benefits?
Ms. Verma. There's a variety of different plans that are
offered under short-term limited duration, and it depends on
the plan.
Mr. Tonko. You are not answering the question.
Ms. Verma. It depends on the plan.
Mr. Tonko. It depends on the plan, but can--again, the
question is, can they refuse to cover essential health benefits
like those I mentioned?
Ms. Verma. They have flexibility on benefit design.
Mr. Tonko. So that is a yes. They have flexibility. Even if
some of these plans might cover some essential health benefits,
I am concerned that what might happen should people get sick
while they have a junk plan.
Administrator Verma, isn't it true that these plans can
impose lifetime and annual limits on coverage and are not
subject to cost-sharing limits?
Ms. Verma. If there were more affordable options available
under Obamacare, people wouldn't have to make compromises. But
unfortunately, premiums have gone up----
Mr. Tonko. I don't want--don't filibuster on me.
Ms. Verma [continuing]. So much that there's no
alternative.
Mr. Tonko. Please. Please. I am asking for a yes or no.
Isn't it true that these plans can impose lifetime and annual
limits on coverage?
Ms. Verma. Yes, they can.
Mr. Tonko. OK. Thank you for the yes. These plans seem to
have very little utility if you need healthcare or don't want
to be one sickness away from bankruptcy. That is exactly why
the ACA was passed. It was to make sure that people had
comprehensive coverage and were not one illness away from
bankruptcy.
So, Administrator Verma, I am curious. What are people with
these junk plans supposed to do when they need vital healthcare
services that are not covered by these junk plans?
Ms. Verma. Well, what are they supposed to do when they
have to spend half of their income on the Obamacare premiums
and then another 10 to 12 thousand dollars on the high
deductibles? They have no alternative. And what our
administration is trying to do is to provide more choices where
there aren't any. And so, when people are forced to pay half of
their income or a third of their income on a premium plus a
deductible, they can't afford health insurance, and short-term
limited duration plans may give them a different option. It's
better than having no insurance at all.
And in absence of no solution by Congress to address----
Mr. Tonko. I am going to reclaim my time.
Ms. Verma [continuing]. Unaffordable premiums, there is at
least something for people.
Mr. Tonko. Well, I believe that the statistics with one in
three people being able to afford something with the subsidies
that we provide are an encouraging statistic. And with that I
yield back.
Ms. Verma. And many people don't get subsidies.
Mr. Tonko. And I would just ask that you put children
first. And with that, I yield back.
Ms. DeGette. The gentleman's time has expired. The Chair
now recognizes the gentlelady from Washington State, Mrs.
McMorris Rodgers, for 5 minutes.
Mrs. Rodgers. Thank you, Madam Chair. I would like to begin
just by giving the Administrator a chance to answer anything
that you didn't get to answer in the last questions since you
were being cut off repeatedly.
Ms. Verma. Thank you. I appreciate that. You know, first of
all, Obamacare has become affordable--unaffordable for so many
families, for the middle class, they can't afford the premiums,
and if they're not getting a subsidy, they have no alternative.
Short-term limited duration plans provide an alternative. I was
just talking to a family where, you know, the husband lost his
job. They have two kids in high school. And they couldn't
afford--they couldn't afford premiums under Obamacare, and so
they looked at a short-term limited duration plan. It met their
coverage needs. They reviewed the benefits and felt like it was
going to work for their family, and so they were able to buy
this plan.
You know, these plans can be 60 percent lower than what's
on the exchanges, and so it gave them an alternative. You know,
they may not need it for a long period of time, but it's
important that we have alternatives. In absence of a solution,
we're trying to do something for the American people, for the
middle-class Americans that can't afford Obamacare.
Mrs. Rodgers. I want to say thank you. I want to say thank
you for your leadership. I want to say thank you for your
commitment to making sure that we keep the promise, especially
to those on Medicare, our seniors that are depending upon
Medicare, for those on Medicaid, some of the most vulnerable in
our country. I just want to say thanks for the work that you
are doing.
I also applaud you for the work you are doing to ensure
that we continue to lead the world in innovation and thinking
of how we ensure that we have a healthcare system that is going
to provide access and quality at an affordable price for
everyone. And I think the flexibility is so important. I think
that offering a variety of plans is so important to meet an
individual's or a family's need, particular needs. Certainly,
Medicare and Medicaid are critical safety nets, and we must
keep, fulfill the promise that we have made to those that are
depending upon Medicare and Medicaid.
I am committed also to making sure that those with
preexisting conditions have the confidence and the certainty
that they will always have quality, access to quality and
affordable healthcare. I have a son with special needs with
disabilities, and I remember during the debate on Obamacare
that I was concerned about the impact that it was going to have
on those with disabilities within Medicaid. According to the
Kaiser Family Foundation, they have reported that more than
450,000 individuals with developmental disabilities are on a
waiting list today for Medicaid in this country--450,000
individuals with disabilities.
When I was, during the debate when I was--when I said I am
concerned about people with disabilities being put on a waiting
list for Medicaid, I was laughed at. Today in Washington State,
15,000 individuals with disabilities are on a waiting list.
This is Washington State that expanded Medicaid to the furthest
degree possible. We have hundreds of thousands of people with
disabilities that are waiting for care. I cochair the Rural
Health Coalition. I have visited hospitals and healthcare
facilities all throughout my district in Eastern Washington. It
is heartbreaking when I hear from providers and hospitals that
are having trouble keeping their doors open because of the low
reimbursement rates and the high populations of Medicare and
Medicaid.
So Washington State is at the highest level, 130 percent of
Federal poverty level are covered under Medicaid. The income
threshold is even higher for children, at 210 percent of the
Federal poverty level. We need to make sure that we are
protecting current beneficiaries because they need to have that
certainty.
I wanted to ask you, could you just talk to me about CMS
and what you are doing to track those that are on waiting lists
and how do we ensure that the populations, some of the most
vulnerable in our communities, are actually getting the care
that we have promised to them?
Ms. Verma. Well, I share your commitment to the vulnerable
populations in the Medicaid program. Many of these individuals
have no place to turn, and Medicare is a vital safety net that
is so critical to improving their lives, the quality of care,
and their day-to-day lives. One of the things that we're very
concerned about is program integrity within the Medicaid
program. We're seeing some alarming data that is showing that
States aren't necessarily putting the right people on the
program, and that we have some high cases and problematic
eligibility systems that are putting people on the program that
don't belong.
And so, we'll be taking action to make sure that we can
ensure that the people on the program actually belong on the
program, because if we don't do that, we're failing taxpayers
and people that deserve to be on the program.
Ms. DeGette. The gentlelady's time has expired. The Chair
now recognizes the gentlelady from Delaware, Ms. Blunt
Rochester, for 5 minutes.
Ms. Blunt Rochester. Thank you, Madam Chairwoman.
And thank you, Administrator Verma, for joining us today.
Today's hearing is critically important because CMS is tasked
with overseeing the implementation of the Affordable Care Act,
the landmark law that allowed thousands of Delawareans as well
as millions of Americans to be protected and not be denied
coverage based on a preexisting condition or removed from their
parents' health plan at the age of 26, just to name a few. It
is one of the significant reasons why I came to Congress, was
to protect this because I know it gave hope to so many people,
particularly people with preexisting conditions.
And, unfortunately, Delaware's enrollment in the exchanges
began dropping in 2016. And that is not a surprise when you
factor in the administration's decisions to, number one,
shorten significantly the enrollment period; number two, cut
the navigator program by 84 percent, causing many people to be
confused and not have the help and support that they needed to
navigate, which--a sometimes incredibly difficult system for
anybody, private sector or public sector; and three, cut
outreach funds by a whopping 90 percent for a program that
doesn't have the longevity of a Medicare or the name
recognition. With less time to apply and fewer resources to do
it, you can understand why people believe that these actions
are deliberate attempts to unilaterally repeal the ACA.
Administrator Verma, after cutting the Federal funding to
facilitate enrollment in HealthCare.gov, you were quoted as
saying, ``This decision reflects CMS's commitment to put
Federal dollars for the federally facilitated exchanges to
their most cost-effective use in order to better support
consumers through the enrollment process.''
I would like to focus on two parts of your statement. One,
supporting consumers during the enrollment process and,
secondly, the cost-effectiveness. According to a former senior
advisor at CMS, Joshua Peck, who previously oversaw the ACA
marketing program, the outreach and marketing programs that
have been dramatically scaled back were working and they were
cost effective.
I have been informed that there is data on how Federal
dollars should be effectively spent in order to reach Americans
who need health insurance. Specifically, a July 2018 general
Government Accountability Office report on HHS outreach and
enrollment efforts in the individual marketplace cites an HHS
study on the most effective forms of advertising for new and
returning enrollees.
In March, I along with 29 of my colleagues wrote from this
committee, reached out to you to ask for this study because we
wanted to really fully understand and get to the bottom of what
ACA marketplace outreach strategies were actually working.
After a follow-up, because I didn't receive a letter after that
one, we wrote another letter. I received a letter back which,
unfortunately, did not give us a direct answer, you know, and I
would like to submit--I would ask unanimous consent to submit
the three pieces of correspondence into the record.
Ms. DeGette. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Ms. Blunt Rochester. Administrator Verma, my colleagues and
I just wanted to understand how CMS can most effectively help
our constituents enroll in ACA-compliant health coverage. And
this one really is a yes-or-no question. Will you commit to
releasing any and all documents, studies, relevant data created
from 2014 onward related to marketing and outreach efforts for
the Affordable Care Act so that we on the committee and
particularly in our oversight role can have the information and
understand that rationale? Yes or no.
Ms. Verma. All document requests are handled by Health and
Human Services, and so I would refer your request to the
Department.
Ms. Blunt Rochester. So the letter that we originally sent
was actually sent to the Department. And it would be great to
also have your commitment, I mean, I am assuming you had to
have made the decision, so therefore you either had information
or you didn't. You--I mean, you made the decision, so it would
be really great to have that information so that we could make
these decisions.
Again, would you support the turning over of that
information?
Ms. Verma. All document requests are handled by the
Department of Health and Human Services, and I would refer your
request to them.
Ms. Blunt Rochester. So I have 10 seconds left, and in my
10 seconds I am going to just say, for many years I got to
serve in public service just like you, deputy secretary of
Health and Social Services, State personnel director. It is
important that people have confidence and faith in these
institutions, and the way we answer questions exhibits that
confidence and faith.
Just answer the questions. Just work with us, because we
all want to see people have healthcare.
Ms. DeGette. The gentlelady's time has expired.
Ms. Verma. And if I have the time--I would be happy to
answer your questions.
Ms. DeGette. The Chair now recognizes the gentleman from
Indiana, Mr. Bucshon, for 5 minutes.
Mr. Bucshon. First of all, thank you, Administrator Verma,
for being here today and thank you for the great work that you
are doing at CMS, a difficult agency to lead, as I would
imagine.
First off, I want to thank you for your recent proposal to
reform Stark Law. As a long-term advocate for reforming the
Stark Law, I am pleased that CMS has proposed real reform to
the law. The Stark Law is a dated regulatory structure designed
for a fee-for-service payment model that has inhibited the
value-based care and coordinated care arrangements that many
physicians are eager to take advantage of in order to provide
better and more efficient care for their patients. As we
rapidly move to value-based care payment models, your proposal
to modernize Stark Law will remove legal barriers that
currently prevent physicians from entering into coordinated
care and innovative payment models, which I believe can lead to
better outcomes for patients and keep costs down.
So I would like to bring up the DME fee-setting provisions
of the proposed rule by CMS that was proposed in July, and
there are some concerns, as you know, that the proposed rule
will place authority in the hands of CMS staff to set Medicare
rates for medical devices in ways that, number one, will expand
disparities between private payor and Medicare reimbursement
and, number two, inhibit the availability of innovative medical
devices for Medicare beneficiaries.
In particular, do you think that a developer of a
breakthrough medical device with fairly robust sales in a non-
Medicare market could review the regulations and then calculate
with reasonable certainty the fee that might be set by
Medicare?
Ms. Verma. You know, one of the things that we're trying to
do around innovation is provide more transparency for
innovations so people understand what they're going to face in
terms of coverage decisions, coding decisions, and also
reimbursements. So we have tried to--we've actually proposed
some regulations that would give more flexibility so that we
can look at the private market and bring in what they may
expect to be reimbursed in the private market as part of our
decisionmaking.
Mr. Bucshon. Thank you. I very much appreciate that. And
so, do you think that in this space that the Medicare fee will
be roughly equivalent to the non-Medicare price?
Ms. Verma. It depends on the particular product. Our goal
with durable medical equipment is to make sure that our
beneficiaries have access to the equipment that they need and
make sure that we have a competitive environment.
Mr. Bucshon. Thank you very much. So I appreciate your
consideration on these issues as you work towards finalizing
that rule.
Another one is a little bit in the weeds but is important.
It is the issue as it relates to Medicare beneficiaries who are
on Coumadin therapy for atrial fibrillation and other medical
problems that require anticoagulation--for example, a heart
valve replacement. As you know, weekly blood tests are required
to keep these patients in the safe treatment range.
And the concern here is, is that this year's proposed
physician payment rule includes a 20 percent reduction in INR,
the International Normalized Ratio, which is a test of
anticoagulation. That is being reduced for 20 percent and is
being reduced for the third year in a row. And so, I would like
to ask if we could hit the pause button and really reconsider
that. Freezing the reimbursement paired with work over the next
year to figure out what is a sustainable path forward will help
ensure that these vulnerable Medicare beneficiaries can receive
the care they need. So I hope that we can take a look at that
and revisit that.
And then, finally, I wanted to thank you for your letter
that your office sent in response to the bipartisan letter that
I sent on September 27th with 24 of my colleagues regarding the
CY20 Physician Fee Schedule proposed rule. My colleagues and I
have concerns with the agency's proposal not to apply a payment
adjustment to the evaluation and management or E&M code
component of global surgical codes even though the agency is
proposing to update the E&M code values for standalone office
visits. And as the agency works to finalize the rule, I
appreciate your ongoing input and collaboration on that issue.
I have 48 seconds left. Do you have anything else that you
feel like you haven't been able to say during the hearing that
you might want to tell the American people about your work?
Ms. Verma. Well, I would appreciate the opportunity to be
able to answer some of the questions that have been posed
before, but we haven't had time. One of the things that I do
want to talk about are the numbers on--the number of people on
Medicaid and the declines there as well as what we're seeing on
the uninsured. When we look at the Medicaid program, it is
natural to see fluctuations in enrollment. As the economy does
better, we can expect to see lower enrollment. We've seen that
in the Clinton administration. There's an urban study report on
this as well.
And so, because we are in a booming Trump economy with the
lower unemployment, less people on poverty, we are going to see
that impact in the Medicaid program. That being said, our
administration is committed to addressing children and making
sure all kids have access to coverage.
Mr. Bucshon. Thank you very much, and I will be submitting
some other questions for the record. I yield back.
Ms. DeGette. The Chair now recognizes the gentleman from
California, Mr. Cardenas, for 5 minutes.
Mr. Cardenas. Thank you very much, Madam Chairwoman. I
appreciate this opportunity to have an open and public
discussion about such an important program to millions and
millions of Americans.
One of the fundamental gains under the Affordable Care Act
was the historic increase in coverage thanks to Medicaid
expansion. Approximately 12 million people gained coverage for
essential healthcare services thanks to this expansion, and it
continues to be one of the most important payors for healthcare
in this country. Studies have made clear that Medicaid
expansion has greatly benefited Americans who gained coverage.
Researchers from the Census Bureau, NIH, UCLA, and the
University of Michigan recently found, and I quote, ``Medicaid
expansions substantially reduced mortality rates among those
who stood to benefit the most.'' They estimated that due to the
States' Medicaid expansion in States that there were over
19,000 fewer American deaths in the first 4 years alone. And
the failure of other States to not expand Medicaid resulted in
an estimated over 15,000 additional American deaths over the
same period.
Administrator Verma, are you aware of that particular
research?
Ms. Verma. I'm aware of it.
Mr. Cardenas. OK, thank you. Other studies also show gains
in access to quality and affordable care as well as positive
health outcomes. And in the midst of the opioid crisis,
Medicaid expansion has increased access to medication-assisted
treatment for opioid addiction.
My question to you, Administrator Verma, is, is it true
that substance use disorder treatment is a top healthcare
priority for HHS?
Ms. Verma. I believe it is, yes.
Mr. Cardenas. OK. That is good to hear. In fact, HHS has
stated that its number-one strategy to combat the opioid crisis
is ``access, better prevention, treatment, and recovery
services.'' And as we know, Medicaid has been integral for
increasing access to those services in expansion States. The
American Medical Association has reported, and I quote,
``Medicaid is on the front lines and often provides more
comprehensive care for substance use disorders than the
commercial insurance market does. There may be opportunities to
extend Medicaid successes to commercial coverage. Expanding
Medicaid would help even more patients.''
So, Administrator Verma, do you agree with the AMA that
Medicaid is critical for providing comprehensive care for
substance disorder to Americans and that expanding Medicaid
would help more American people who are suffering from
addiction?
Ms. Verma. Thank you. A couple things. One, on Medicaid
programs, CMS has approved 26 State Medicaid 1115
demonstrations to expand.
Mr. Cardenas. How many States in the union?
Ms. Verma. There's 50 States in the union, 26 States.
Mr. Cardenas. OK, thank you. So just over half.
Ms. Verma. But those are the ones that have applied, and if
they've applied we've approved them. So we have tried to ensure
that people with substance use disorder have a full array of
options available to them and more places to receive treatment.
Mr. Cardenas. So the States that have applied and are
providing that service, are they doing better than the States
that are not applying in this category?
Ms. Verma. These waivers, we just started granting them
probably late 2017, and so we're still evaluating those
waivers.
Mr. Cardenas. When do you anticipate having evaluations
that you could report to Congress?
Ms. Verma. We'll be happy to share any information that we
can with you.
Mr. Cardenas. About when? Is it 2019, 2020, 2030?
Ms. Verma. You know, it depends on when it comes in. These
are 5-year waivers.
Mr. Cardenas. OK, 5-year.
Ms. Verma. And so it would take us at least that, and it
depends on when they started their waiver.
Mr. Cardenas. OK. Thank you so much.
As we know, the Trump administration is rooting for the
ACA's demise by asking the court to strike down the entire law.
But if that happens, Medicaid expansion would be reversed.
Therefore, 12 million American people would lose coverage
literally overnight.
Administrator Verma, if the administration gets its way in
the Texas v. United States lawsuit, what will happen to those
12 million vulnerable people who suddenly find themselves
without coverage?
Ms. Verma. Well, we're rooting for all Americans to have
coverage, and under the Affordable Care Act, the middle class
can't afford Obamacare's coverage.
Mr. Cardenas. I asked you specifically about that lawsuit
and what would happen to those 12 million Americans.
Ms. Verma. And we've been very clear, the President's been
very clear he wants to make sure that people with preexisting
conditions would have protections and we want to make sure that
all Americans would have access to affordable coverage.
Mr. Cardenas. OK, thank you. Reclaiming my time. That is
not the answer to the question I specifically asked.
I would like to state for the record that the Trump
administration and Administrator Verma are paying lip service
to caring about American people with these issues, but it is
clear that not taking the steps to encourage the best thing a
State can do to immediately improve the lives of millions of
American residents of those States that it expands--that it
should be expanding Medicaid.
I am out of time, Madam Chair. I yield back.
Ms. DeGette. The gentleman yields back. The Chair now
recognizes the gentleman from Montana, Mr. Gianforte, for 5
minutes.
Mr. Gianforte. Thank you, Madam Chair. And thank you,
Administrator Verma, for being here today to testify in front
of our committee.
Last year, Congress removed Medicare reimbursement
restrictions in five areas, including telestroke services. Do
you think telehealth would be useful and effective in other
critical care scenarios, especially for rural hospitals like I
have in my district that may not have specialists in these
small communities?
Ms. Verma. Absolutely. And I think that's one of the things
that we're trying to focus on in the Medicare program and part
of the reason why I have some concerns when you hear about
proposals to put everybody into the Medicare program.
Unfortunately, the Medicare program often is very slow to
respond to new technology. That being said, our administration
has focused on telehealth services. We've expanded the number
of telehealth services that are available in rural communities
and we've also provided remote communication technology to the
entire program so our beneficiaries can easily access care.
Mr. Gianforte. OK, I want to dig into this a little more.
The Federal Government is among the most prolific users of
telehealth and virtual care technologies, including the VA,
DOD, IHS, NASA. Unfortunately, just one-quarter of 1 percent of
Medicare fee-for-service beneficiaries used telehealth in 2016.
Meanwhile, the Government has funds, grants, projects through
HRSA, SAMHSA, FCC, and others. We know that some grants may be
duplicative across HHS operating divisions, and it is often
difficult for healthcare providers and patients to understand
how they can better access telehealth services.
With limited resources available for telehealth adoption,
it is important that we spend all these funds wisely. Can you
help us understand how these different entities across the
Federal Government coordinate policy development, Federal
funding opportunities, and best practices as it relates to
telehealth?
Ms. Verma. Sure. One of the things that we have going on at
Health and Human Services is the Secretary has convened a Rural
Health Committee. And so we have--he's bringing together all of
the agencies under HHS to focus specifically on rural health,
and as part of those discussions we're talking about how we can
expand telehealth services to make sure not only people in
rural communities but even urban communities can access those
services.
Mr. Gianforte. OK. And do you believe there is
opportunities to exist to improve coordination and efficiencies
further?
Ms. Verma. Absolutely.
Mr. Gianforte. OK. Are you aware of any national telehealth
strategy and, if not, should one exist?
Ms. Verma. I think there's been some focused effort on
this in rural communities to make sure that--you know, a lot of
the problem is, even if telehealth services are available, they
may not have broadband access, and so the administration has
focused on that as well. You know, telehealth is a great
example of innovative technology that can really go a long way
to improve access and to improve healthcare and outcomes, and
so would love to continue to work with you on that issue.
Mr. Gianforte. Well, it is a real area of attention for us
given I represent the State of Montana. We have a lot of space
and not many practitioners. We don't have specialists.
Telehealth is one way to bring those to these rural communities
so they can maintain the viability of our critical access
hospitals and others. So I appreciate all that CMS has done to
increase access to telehealth services.
The Federal Government has a commitment to keep to our
seniors and ensure they have access to high-quality, affordable
healthcare. Congress should focus on leveraging both Federal
funds and lessons learned so that those who need access most
have it, particularly folks in rural areas. We should
prioritize efforts to expand telehealth access and fully
realize the potential it has to provide services to all our
seniors with access to reliable, quality healthcare.
I have a minute left. Is there anything else you would like
to tell the American people that hasn't been addressed today?
Ms. Verma. I would like to focus on some of our efforts
around rural health because I think it's an important area.
We've been concerned about the hundred hospitals that have
closed, rural hospitals. We're also concerned that 40 percent
of rural hospitals are operating at a negative margin. This is
why we've taken action with the wage index to increase
reimbursement to hospitals in rural areas, and we're also
working on something, a new model for rural communities to
basically think about how they can redesign their system.
I think those decisions need to be made at the local level,
can't be made in Washington, but it's an opportunity for them
to rethink the structure and to move in more value-based care.
So we're excited to continue our work and our commitment to
rural communities across America.
Mr. Gianforte. Again, I want to thank you for your work at
CMS and thank you for being here today. And with that, I yield
back.
Ms. Verma. Thank you.
Ms. DeGette. The gentleman yields back. The Chair now
recognizes the gentleman from Illinois, Mr. Rush, for 5
minutes.
Mr. Rush. I want to thank you, Madam Chair. And welcome,
Administrator Verma.
Administrator Verma, last month I sent you a letter asking,
to me, a very important question: Why are there so many
dialysis centers in black neighborhoods? In the poor part of my
district, it seems that there is a dialysis center on each and
every corner. And I want to thank you for responding to my
letter, and I am cautiously optimistic regarding CMS's
aggressive goals to reduce the disproportionate rates of kidney
disease in lower-income and minority communities.
Madam Chair, I ask unanimous consent to offer my letter to
CMS and to offer their response into the record.
Ms. DeGette. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Rush. Administrator Verma, will you describe in detail
how the goals you outline in your response to me will ensure
minority communities in particular that they will have access
to the care and education on treatment options that they may
require if they are on dialysis?
Ms. Verma. Well, thank you for your question. This is an
important area. The President has actually put out an executive
order around kidney disease, and the goal of that is
multifaceted. First of all, we want to improve the quality of
care. We want to make sure that people that are living with
kidney disease have options about their care. The first thing
that we want to do is make sure that the transplants, that the
ability to have a transplant to cure their disease is
available. And we know that there's a lot of regulations that
get in the way of having more organs be available, and so the
President has asked us to take action on that issue.
The second thing we want to do is make sure that we're
paying doctors for the quality and the outcomes that they
achieve. And one of the things that we want to focus on is
giving people living with kidney disease more options so that
they don't necessarily have to go into a dialysis treatment
center and they can have more home-based dialysis.
Mr. Rush. Ms. Verma, I want to know about the dialysis
centers and those patients who are on dialysis, not those
patients who are looking for organ transplants. And that is
really good, but please center your answers on the issue of the
dialysis center epidemic in lower and minority communities
throughout the Nation, certainly in my district.
Ms. Verma. Well, I think that's what this executive order
focuses on. We want to improve the quality of care. We want to
make sure that people have options. That they're not forced to
just go to a dialysis center, that they can even receive that
care at home.
Mr. Rush. So you don't have an answer to my question?
Ms. Verma. Well, I think our executive order, writ large,
focuses on it, on kidney care.
Mr. Rush. Well, let me ask you another question then.
I am concerned about hospitals closing in my district and
in similarly situated districts across the Nation, all right.
What do you have, any data on closures of hospitals in lower
and minority income communities across the Nation?
Ms. Verma. I'm sorry. The question is, you want to
understand the impact on----
Mr. Rush. I want to know, do you have any data on the
number of hospitals that have been closed in my district and
lower-income and minority districts across the Nation within
the last 5 years?
Ms. Verma. I don't have that data with me today, but I can
commit to you that we can help your office and provide any data
that we have available to your office.
Mr. Rush. Do you know why there is an increase in the
number of hospitals that are closing in lower and minority
income communities?
Ms. Verma. I have not studied that issue, but I'd be happy
to work with my team and get you that information.
Mr. Rush. Can you come up with any idea about how to
prevent hospitals from closing in minority and low-income
communities across the Nation if, in fact, the data reveals
that we have such an epidemic?
Ms. Verma. Well, we want to make sure that people all
across the Nation have access. I think we've looked at the
issue in rural areas----
Mr. Rush. I yield back.
Ms. Verma [continuing]. But happy to work with you on that.
Ms. DeGette. The gentleman yields back. The Chair now
recognizes Mr. Carter from Georgia for 5 minutes.
Mr. Carter. Thank you very much, Madam Chair. And,
Administrator Verma, thank you for being here. We appreciate it
very much. Is there anything you need to respond to before I
get--you are OK? OK.
I want to thank you. I have been working with you now for
close to 2\1/2\ years, and I appreciate your work. I think you
understand what we are trying to do, and I think we are on
board. I want to especially tell you how much I appreciate the
proposed rule changes earlier this year concerning rebates with
PBMs and especially with DIR fees. And whereas I know you have
to temper your remarks, but I don't, I was devastated that they
did not--that the administration blocked those rules and that
we weren't able to get them through, and I hope that you will
continue to work toward that.
I, for one, believe that we need to do away with PBMs, and
I certainly believe we need to do away with DIR fees. Both of
them need to be eliminated. But one thing that I don't think
needs to be eliminated is the 340B program. I do think it
serves a useful purpose. However, I do think it needs to be
updated, and I think that we need to tighten up that program.
There are flaws in that program, and it can be better than what
it is now if we simply make some changes to it.
We did a study in the last Congress about the 340B program
and made some recommendations, and one of the things that we
cited was duplicate discounts. The discounts that are going to
the recipient, the covered entity receives a rebate for the
drug that is dispensed to the patient and the Medicaid agency,
and it can be both the State Medicaid drug rebate plan or the
Medicare managed care plan.
And I just wanted to ask you, whereas I know HRSA has
primary jurisdiction over the 340B program, CMS has
jurisdiction over the Medicaid program. What are we doing about
that? Can you help me?
Ms. Verma. Sure. And I also do want to address the DIR
fees. What I will say is we're very concerned about small
pharmacies and we want to make sure that our policies ensure a
competitive marketplace, and I can tell you that the agency
continues to work on that issue. We're particularly concerned
about some of the quality metrics that may be impossible for
some of these pharmacies to comply, so we're going to continue
to do what we can under the law.
Mr. Carter. And, of course, as you well know we are trying
to address it legislatively as well, and I want to thank my
colleagues on the other side of the aisle for assisting in that
as well.
Ms. Verma. Thank you. And then, in regards to the 340B
program, as you know that is the subject of litigation, so I
won't get into that, but we are concerned about the double
discounts. At the end of the day, some of the proposals that we
made would result in our seniors paying less, and we're
concerned about that. I also would add that the President's
budget in terms of the 340B project or our proposal would say
that if we made any changes to the 340B program that any
savings could be directed back to the safety net institutions.
And so, I would ask that you take a look at that because I
think that would be helpful in reforming the program, ensuring
that beneficiaries are paying less when they get their
medications but also ensuring that we support safety net
institutions.
Mr. Carter. Absolutely. And I don't mean to be redundant,
but again as I said earlier, I am not opposed to the program.
It just needs--we need to upgrade the program, and we need to
make it even better, and we can make it even better.
OK, and then let's shift over to your oversight of hospital
accrediting organizations because I know that is your
responsibility as well. And it is my understanding that you
have a new pilot program out there that is dealing with the
``increase the agency's oversight of organizations involved in
accrediting and inspecting most hospitals''?
Ms. Verma. I think, one--we do have, we had an RFI out on
this. One of the things that we've had some concerns about is
that organizations that are reviewing safety and quality at
hospitals--we put out an RFI because we've also heard some
concerns that these organizations are also receiving consulting
dollars from those same entities, so we're taking a look at
that. We want to make sure that the American public can count
on the accreditation and that they have the information that
they need about the hospital at their fingertips.
Mr. Carter. Obviously that is a conflict of interest, if
they are doing the consulting and the accrediting. Is the pilot
program in place, or you just have an RFI for it?
Ms. Verma. We--so there's two different issues. One is
around the accreditation issue and conflicts of interest. The
other issue that we have in place is just looking at, we have a
pilot program to do joint review so that we can have our
oversight of the accrediting organizations and that we
basically do the review of the hospitals at the same time so
that we're not duplicating that. We're going to see how that
goes.
Mr. Carter. Great. And again, I want to thank you for all
your work and especially for your work on the DIR fees, because
as you say, particularly for small pharmacies, which we need in
this country, this is devastating for them. So thank you, and I
yield back.
Ms. Verma. Thank you.
Ms. DeGette. The gentleman yields back.
I want to thank our witness for her participation in
today's hearing, and I want to remind Members that, pursuant to
committee rules, they have 10 business days to submit
additional questions for the record to be answered by the
witness who has appeared before the subcommittee.
Administrator Verma, I would ask that you agree to respond
promptly to any such questions should you receive them. And
with that, the subcommittee is adjourned.
Ms. Verma. Thank you.
[Whereupon, at 12:31 p.m., the subcommittee was adjourned.]
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