5 things to know from questioning of Trump’s CMS nominee

Seema Verma, MPH, President Donald Trump’s pick to run CMS, faced questions about mandatory payment models, the Affordable Care Act (ACA), and providers’ ability to take on risk-based arrangements in her confirmation hearing before the Senate Finance Committee.

Unlike the contentious nomination of HHS Secretary Tom Price, where Democrats on this same committee attempted a boycott, Verma appears to have an easier path for approval. Democratic Indiana Sen. Joe Donnelly introduced her to the committee, indicating he’ll vote for her when her confirmation advances to the full Senate. He praised her work on crafting the Healthy Indiana Plan (HIP), the state’s version of Medicaid expansion.

“Today, HIP 2.0 has helped to lower our state’s uninsured rate, improve healthcare outcomes and has played a critical role in combating the opioid abuse and heroin use epidemics,” Donnelly said.

Here are five key takeaways from Verma’s answers at the hearing:

1. She thinks maternity coverage should be optional

Verma repeatedly emphasized giving extra “choices” to patients when asked about minimum insurance benefits required by the ACA. When pressed by Sen. Debbie Stabenow, D-Michigan, about what they would that mean for provisions in the law on covering pre-natal and maternity care, Verma said she favored patients determining insurance benefits that they need, not lawmakers or regulators.

“Obviously I don’t want to see women being discriminated against. I’m a woman and I appreciate that,” Verma said, “but I also think women have to make the decisions that work best for them and their family. Some women might want maternity coverage and some women might not want it, might not choose it, might not feel like they need that.”

2. She’s skeptical of mandatory payment models

Verma said she’s supportive of “efforts around innovation,” but like Price, doesn’t seem to like making tests of alternative payment models, like bundled payments, mandatory for providers.

“We need to make sure we’re not forcing, not mandating individuals to participate in an experiment, a trial that there’s not consent around,” Verma said.

She added that she believed expansion of those models should be done more gradually, sticking to a smaller scale with more time to evaluate whether those programs are improving outcomes or producing savings. She also said Congress should be involved in discussions about expanding those models “before it becomes formal policy.”

3. She considers MACRA a “step forward,” but is concerned about challenges to small, rural providers

To open the hearing, Chairman Orrin Hatch, R-Utah, asked Verma about the Medicare Access and CHIP Reauthorization Act (MACRA) and how she would implement its Quality Payment Program (QPP). Verma called the law “an important step forward.”

For smaller providers or those in rural areas, however, Verma said the new payment tracks would be “challenging,” and asking those providers to take on risk-based arrangements may not be possible.

“I don’t know if small providers, rural providers want to take risk at all,” Verma said, noting that some larger healthcare systems have shied away from taking on downside risk.

Sen. Ron Wyden, D-Oregon, suggested her answer sounded like she supports keeping fee-for-service arrangements. Verma said that’s not her position.

“I’m not suggesting that (fee-for-service) works better,” Verma said. “I support efforts to increase coordination of care and hold providers accountable for outcomes. It’s another thing altogether to have them accepting risk.”,

4. She wouldn’t discuss the proposed rule for ACA exchanges

Wyden and Stabenow both asked for Verma’s opinion on the proposed rule for the ACA marketplace released by CMS the day before her hearing. When pressed for an opinion on provisions like cutting the open enrollment period in half, she repeatedly declined to give one.

“Out of respect for this process, I have not been to HHS, have not been to CMS and have not been involved in the development of that rule,” Verma said, adding that she will review the proposal if she’s confirmed.

5. Democrats weren’t happy with some non-committal answers

The ACA rule was one of several areas where Verma either declined to give her opinion or didn’t directly answer questions posed by Democrats. Among the topics she avoided were how to meet Trump’s stated goal of “insurance for everybody” or whether she supports allowing Medicare to negotiate drug prices.

“Respectfully, I didn’t get a specific (answer), we’ll hold the record open for it,” Wyden said.