On February 19, 2021, President Joe Biden nominated Chiquita Brooks-LaSure to serve as the Administrator for the Centers for Medicare and Medicaid Services (CMS). If confirmed by the Senate, Brooks-LaSure would be the first Black woman to lead the agency. In this article we look a little more into her background and experience.
Brooks-LaSure formerly oversaw implementation of the Patient Protection and Affordable Care Act (ACA) in the Obama Administration in her role as Deputy Director of CMS’s Center for Consumer Information and Insurance Oversight, which oversees health insurance markets. Before working in the Obama Administration, Brooks-LaSure served as a professional staff member on the U.S. House Ways and Means Committee, where she worked with then-Congressman and Committee member Xavier Becerra, whom President Biden has nominated to lead HHS. She also worked as a Medicaid analyst in the Office of Management and Budget. Brooks-LaSure comes to the post having familiarity with President Biden’s team. She co-led then-President-elect Biden’s review team covering HHS. Brooks-LaSure’s nomination has already drawn praise from industry groups, such as the American Hospital Association and the Association of American Medical Colleges.
Brooks-LaSure authored a paper for Health Affairs defending the ACA’s record in increasing health care coverage. She noted that coverage for the poor “remains the most significant unfinished business of the ACA,” which she said is the result of 14 states declining to expand Medicaid in the years since the law was passed. She described several possible policy proposals to address this lack of coverage among some segments of the population. Among these is to financially encourage states to expand Medicaid by temporarily increasing the Federal Medical Assistance Percentage (FMAP) to 100 percent and to expand eligibility for marketplace subsidies.
In June 2019, Brooks-LaSure testified before the U.S. House Committee on Ways and Means in a hearing titled “Hearing on Pathways to Universal Health Coverage.” The hearing was reportedly designed to respond to pressure from House Democratic Caucus progressives supporting Medicare-for-All proposals and was described by one media outlet as “the second ever hearing on Medicare for All.” At the hearing, Chairman Richard Neal (D-MA), introduced Brooks-LaSure as an expert who “examines State and Federal health reform policy and proposals, including the buy-in and public option opportunities.”
In her testimony, Brooks-LaSure lauded the ACA for its expansion of health care coverage, but cautioned that she believed more must be done, saying, “14 States have not expanded Medicaid, leaving 2.5 million Americans in the coverage gap.” She provided an overview of proposals that would retain the existing health insurance paradigm while expanding coverage, including a Medicare buy-in option for non-eligible individuals while keeping the current program intact.
Additionally, stakeholders can expect Brooks-LaSure to prioritize equity and potentially propose to collect data regarding equity and impose new or enhanced requirements promoting equity.
In the 2019 Ways and Means Committee hearing on universal health care, Brooks-LaSure emphasized inequities in the health care system. She cited maternal mortality statistics, indicating “African American women, regardless of insurance status, are four times more likely to die in childbirth than white women.” In her view, the COVID-19 pandemic has illustrated underlying “cracks in our health system,” that could be corrected by Medicaid expansion, saying poor individuals have “no access to coverage because their states have not expanded Medicaid.”
In a 2020 article on maternal health disparities, Brooks-LaSure emphasized that key challenges facing many pregnant women are complex and changing benefits eligibility and maintaining continuity of coverage. Brooks-LaSure’s preferred solution is to ensure enrollment through health care navigators: “This is clearly an area where states can help make sure that the various groups that help people enroll in coverage today are funded and be aware of this issue.” Also in 2020, she stated that she favored data collection from “providers and health insurers in Medicare, Medicaid, and private insurance,” which is “a critical component to identifying and solving health inequities.”
Brooks-LaSure will also oversee CMS at a time when it implements surprise billing regulations. FairHealth, where Brooks-LaSure serves on the Board of Directors, has engaged in educational discussions with federal and state lawmakers on approaches to banning surprise billing. In an issue brief on various policy solutions, FairHealth concludes, “Designing the best solution for every jurisdiction requires a nuanced evaluation of different options and a realistic appreciation of the implications of different legislative paths. Toward that end, it is critically important to use real-world data, reflecting actual healthcare economics in local markets, as a flashlight to shine in the corners of legislative discussions.” If FairHealth’s positions are any indication, we expect Brooks-LaSure to afford a level playing field for both providers and insurers in implementing a ban on surprise billing.