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tv   CMS Administrator Nominee Seema Verma Testifies at Confirmation Hearing  CSPAN  February 17, 2017 10:03am-10:34am EST

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where she supports raising medicare's eligibility age or allowing the government to negotiate with drug companies for lower prices. senator orrin hatch of utah chairs the nearly three-hour hearing. senator hatch: the committee will come to order. i'd like to welcome everyone to the -- to this morning's hearing. today we'll consider seema verma to serve as administrator
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at centers for medicare and medicaid services. welcome, ms. verma. we're so happy to have you here and your family as well. i appreciate your willingness to lead this key agency at this critical time. and i see that your family has joined you here today to lend support so i extend a warm welcome to all of you and to them as well. c.m.s. is the world's largest health insurer, covering over 1/3 of the u.s. population through medicare and medicaid alone. it has a budget of over $1 trillion, and it processes over 1.2 billion claims a year for services provided to some of our nation's most vulnerable citizens. ms. verma, having dealt with c.m.s. extensively in your capacity as a consultant to numerous state medicaid programs, you know full well the challenges the agency deals with on a daily basis. and i suspect you also know the
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job you've been nominated for is a thankless one fraught with numerous challenges. the good news is there are opportunities in those challenges, and i believe you're the right person for the job and that you will make the most of those opportunities to improve our health care system. the failings of obamacare are urgent and must be addressed in short order. over the past six years, we have watched as the system created under obamacare has led to increased costs, higher taxes, fewer choices, reduced competition and more strains on our economy. under obamacare, health insurance premiums are up by an average of 25% this year alone. under obamacare, americans, including millions of middle-class americans have been hit with $1 trillion in new taxes. and under obamacare, major insurers are no longer offering coverage on exchanges and
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earlier this week, we learned another major carrier will exit the market in 2018. as congress works to change course with regard to our ailing health care system, c.m.s. will play a major role in determining hour success. i applaud the step the agency took yesterday under the leadership of h.h.s. secretary price with the supposed rule to help -- with its proposed rule to help stabilize the individual insurance markets. but there's much more work to be done, and i'm confident if you're confirmed -- and i expect you to be -- you will be a valuable voice in driving change. i'd like to talk specifically about medicaid for a moment. the medicaid program was destined to be a safety net for the most vulnerable americans. as such, i understand and value the moral and social responsibilities the federal government has in ensuring health care coverage for our
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most needy citizens. i am committed to working with the states and other stakeholders as i think everyone on this committee is and, of course, the american public to improve the quality and ensure the longevity of the medicaid program. we must also acknowledge that the medicaid program is three times larger both in terms of enrollment and expenditures than it was just 20 years ago. additionally, the medicaid expansion under obamacare exacerbated pressures on the program at a time when many states were already facing difficult choices about which benefits and populations to serve. and as a result, we have the responsibility to consider alternative funding arrangements that could help to preserve this important program. we also need to consider various reform proposals that can improve the way medicare operates. ms. verma, we will need your
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assistance in both of these efforts, and your experience in this particular area should serve you well. on the subject of ms. verma's experience, i want to note for the committee that she has been credited as the creative force behind the healthy indiana plan, the state's medicaid alternative. this program provides access and quality health care to its enrollees while ensuring that they are engaged in their care decisions. the program continues to evolve while hitting key metrics and overall enrollees are very satisfied with their experience, as i understand it. while we may hear criticisms of this program from the other side of the dias here today, we should note that h.h.s. and c.m.s. leaders under the obama administration repeated the approved the waiver necessary to make this program a reality. ms. verma has assisted a number of other state medicaid
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programs as well. her efforts all have the same focus, getting needed high-quality health care to engaged patients -- and tone gauge patients in a fiscally -- and to engage patients in a fiscally responsible way. this is exactly the mindset we need in a c.m.s. administrator. now, ms. verma, as if the challenges associated with medicaid are not enough to keep you busy, as c.m.s. administrator, you will also be tasked with helping to ensure the longevity and solvency of the medicare trust fund which is projected to go bankrupt in 2028. that's already down from 2032, i believe. all told between now and 2030, 76 million baby boomers will become eligible for medicare. even factoring even deaths during that period, the program
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will grow from approximately 47 beneficiaries today to roughly 80 million in in 2030. maintaining the solvency of the program while providing care to an ever expanding beneficiary base is going to require creative solutions. it will not be easy. we can't put it off forever and the longer we way the worse it will get. now that i've had a chance to discuss the challenges facing c.m.s. and some of ms. verma's qualifications, i would like to speak more generally about recent events. we've gone through a pretty rough patch recently on this committee, particularly as we've dealt with president trump's nominations. i don't want to rehash the details of the past few weeks, but i will say i hope that recent developments do not become the new normal for our committee. as i said before, i'm going to do all i can to restore and maintain the customs and traditions of this committee,
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which has always operated with assumptions of bipartisanship, comity and good faith. with regard to considering nominations, that means a robust and fair vetting process. a rigorous discussion among committee members and, of course, a vote in an executive session. on that note, maybe the icy treatment of nominees is starting to thank you today. at least -- to thaw today. at least i hope it is. one thing that's been absent before this session is the introduction on many occasions of nominees by senators of both parties, from the nominee's home state, especially in cases where the nominee and the home state senator have a relationship. i'm pleased to say the senior senator from indiana is reaffirming that tradition by appearing here today. and so is our other senator from indiana. i thank these senators for taking time to appear today and to introduce their constituent.
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i'll give them a chance to do so in just a few minutes. with that i look forward to ms. verma's sharing her vision and views here today and i will be forward to what i hope will be a full and fair committee process. that allows us to process this nomination and report it to the full senate in short order. i'll now at this time recognize my co-chairman in this committee, senator wyden, for his opening statement. senator wyden: thank you very much, mr. chairman. welcome to you, ms. verma, and to our colleagues from indiana. i just thought it was worth noting that with the hoosier basketball tradition, ms. verma, it looks like you have brought close to two squads of basketball players and we welcome you and your family today. it's obvious that the health care post that we're going to discuss today is not exactly dinner table conversation in
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much of america. but the fact is, it is one of the most consequential positions in government. agencies responsible for the health care of over 100 million americans who count on medicare and medicaid. it plays a key role in implementing the affordable care act, and that's why c.m.s. needs experienced and qualified people for the job. people who know the ends and outs of the whole system, medicare, medicaid and private insurance. the agency needs a strong and experienced authority, and this is particularly true now when it does appear that some of my colleagues on capitol hill, many in the administration, are looking to make radical changes in american health care. in my view, many of these proposals would take the country back to the days when health care was mostly for the healthy and the wealthy. so we're going to start with the promise of medicare, which has always been a promise of
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guaranteed benefits. that makes up more than half of the agency's spending, about $2 billion-plus a day. with more seniors entering the program each year, there's an awful lot to do to protect and in my view update the medicare guarantee for this century. that means addressing the high cost of prescription drugs. it means making the program work better for those with chronic illnesses like heart disease and cancer. that's the majority of the medicare spending today. it's going to take bipartisan support. privatizing medicare is in the wrong direction in my view. it's important to hear today, ms. verma, how your views differ from some of the policymakers who are advocating for those kind of approaches who would literally be interested in turning the program into a voucher system.
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additionally, if confirmed you are going to play a key role implementing the medicare physician payment reforms. it's essential that they be implemented as intended by the congress because we want to start moving health care from paying for volume to paying for value. also, the agency implements rules of the road in the private insurance market, and today many of those rules amount to bedrock values for health insurance in the country. it means not discriminating against those with a pre-existing condition no matter what. it means setting the bar for what type of medical care insurance companies has to cover, and it means letting young people stay on their parents' policy until 26. unfortunately, just yesterday the agency released a proposed rule that in my view goes in the opposite direction. from where i sit, the message
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from yesterday's rule is insurance companies are back in charge and patients are going to take a backseat. the open enrollment period, for example, was cut in half from three months to six weeks. if somebody dropped coverage during the year for any reason, insurance companies could collect back premiums before an individual can get health insurance again. and insurance companies would have free rein to offer less generous coverage at the same or higher cost. this, again, sounds to me like it's going back to yesteryear when the health care system really did work for the healthy and wealthy. now, the administration has been saying, of course, that the best is yet to come. evidence, it seems to me, suggests otherwise. the president could have taken steps to create more stability on a bipartisan basis, but instead issued an executive order on the day he was sworn in that is obviously now
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creating market uncertainty and anxiety. you don't have to look much further than humana's decision here in the last day or so. so we want to hear from you, ms. verma, this morning about how you're going to implement this program that millions of americans, you know, count on, and how you're going to do it even though we have republicans here who want to unravel the law. in short, i want to see us get beyond what has come to be known as repeal and run, and repeal and run goes beyond disrupting the individual market. it would also -- and the medicaid expansion that brought millions of low-income vulnerable americans into the health care system. and this is an area obviously where you have extensive experience. i want to discuss some of the tradeoffs associated with those efforts, and i'm particularly concerned about the possibility, as i've been
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informed, that somebody making barely $12,000 a year would get locked out of health coverage for no less than six months because they couldn't pay for health care due to an upcoming rent check, for example, or an emergency car repair. there's been an independent evaluation indicating that 2,500 people were bumped from coverage due to situations like this. i've also seen in that same report that more than 20,000 persons were pushed into a more expensive, less comprehensive medicaid plan because they couldn't navigate the system that you all put in place. now, i want to wrap up with just two last points, mr. chairman. one, with respect to taking these ideas on a nationwide tour, i'm not there yet. i say that respectfully. we'll hear more about the program, and here's the point with respect to the states. we touched on it in the office.
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we authored section 1332 of the affordable care act saying that states can do better. if states have an idea, better coverage, lower costs, god bless them. we're all for it, but we can't use 1332 or any other provision for the states to do worse. one last issue that i want to touch on deals with ms. verma's work. as i understand it, you had a consulting firm. y'all were awarded more than $8.3 million in contracts directly by the state to advise the state, and that was while y'all were managing the programs. in fact, you were the architect. at the same time, in told to me, you contracted with at least five other companies that provided hundreds of millions of dollars of services and products to these programs. .p. enterprises, milliman,
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rosch diagnostics. in at least two of these firms, h.p. and h.m.a., the terms of the state contracts appear to have had you in effect overseeing work that the firms performed. now, george w. bush had an ethics lawyer, rachede paynor -- richard paynor. wasn't exactly a liberal guy. he said this arrangement, i'll quote him, clearly should not happen and is definitely improper. in effect said you are on both sides of the deal helping manage state health programs while being paid by vendors to the same programs. he said that was a conflict of interest. i want to hear you respond to his assertions. so we're going to want to know more about your work that did business with the state and one of the questions will be if you're the c.m.s. administrator
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if you're confirmed, would you recuse yourself from decisions that affect the companies that work with the clients. i look forward to your testimony and hearing from the two senators. you're running with the right crowd. senator hatch: i want to yield to a pair of our distinguished colleagues. the hoosier from state will introduce ms. verma to statement and testament her work and as a person. i ask that senator donnelly start the introduction and then turn it over to senator young. senator donnelly, you go ahead and proceed. senator donnelly: thank you, mr. chairman. chairman hatch, ranking member wyden, members of the committee, thank you for inviting me here today. it is a pleasure to be here with my friend and colleague, senator todd young, to recognize this important
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accomplishment of a fellow hoosier. as you know, anytime the president nominates an individual for a leadership position in our government, it is an honor and a reflection of the tremendous trust and respect he has in that person. for this reason i am pleased to be here today to help recognize ms. seema verma for her nomination to be the next administrator for the centers for medicare and medicaid services, c.m.s., and introduce her to this committee for your consideration. i've always held a personal belief that we accomplish more when we work together. in indiana we call that hoosier commons. in working clab -- common sense. in working collaborative to help hoosiers get access to quality health care is something ms. verma and i had an opportunity to do together. as many of you are already aware, ms. verma has played a central role in crafting medicaid policy in many states, including our own. in indiana, she worked with governor daniels and then
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governor pence as well as other state and federal partners to take advantage of opportunities made possible by the affordable care act to expand medicaid through the healthy indiana plan, also known as h.i.p. improved p.-2.0 has health care outcomes and has played a critical role in combating the opioid abuse and heroin use epidemics. hundreds of thousands of hoosiers currently have health insurance through h.i.p. 2.0 and the program is an example of what is possible when we work together. as i have shared with ms. verma and i will share with you, i am deeply concerned about the future of health care in our country as well as the rhetoric surrounding the current debate. i firmly believe that maintaining access to critical programs like medicaid and medicare and building upon the progress of the a.c.a. is
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fundamental to both the physical and financial well-being of thousands of americans across our country. it is my sincere hope that this administration, working with this committee and others, will approach medicare and medicaid with the thoughtful and pragmatic consideration these critical programs deserve. i have watched ms. verma take this commonsense hoosier approach, and i hope she uses this opportunity today to share with you her vision for how she can work together with all of the members of this committee and congress as a whole to expand access to quality health care and protect and build on the progress we have made over the last several years. with that, chairman hatch, ranking member wyden, members of the committee, thank you for allowing me to introduce ms. verma. to ms. verma and her family, congratulations on this tremendous honor. i look forward to ms. verma's testimony, and i thank the committee for your hard work
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and your consideration of ms. verma for this very important position. senator hatch: well, thank you very much, senator. you now can proceed. senator young: well, thank you, chairman hatch, ranking member wyden, and members of the committee. it's truly an honor to be with you to introduce a fellow hoosier, seema verma, to be administrator for centers for medicare and medicaid services. you know, president trump simply could not have made a better choice in selecting seema to lead what is arguably the most important office within h.h.s. an office that covers the health care needs of over 100 million americans with a budget of almost $1 trillion. in her 20-year career as an innovator in the health care sector, she's worked extensively with a variety of stakeholders from both sides of the aisle to deliver better access to health care. as president, c.e.o. and
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founder of s.f.v., she helped several states to redesign their archaic medicaid systems, including in my home state of indiana. seema revolutionized the medicaid program as architect of the healthy indiana plan which yes know as h.i.p. it's the nation's first consumer-directed medicaid program. she transformed a complex, rigid medicaid system into one where hoosiers are back in control of their health care needs. since 2007, h.i.p. has achieved impressive results. hoosiers are more likely to seek preventative care, take their prescription medications and seek primary care services at their physician's office, not the emergency room. seema's innovative ideas are working and now is an important proof of concept that medicaid can be more efficient than a
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one-size-fits-all approach. and she accomplished this with the support and buy-in from people, again, on both sides of the aisle and at all levels of the process. by putting the mission above politics, she demonstrated a willingness to work with anyone , anyone who was willing to do the same. she worked with democrats in the indiana state house. she worked with the obama administration to find common ground on how to best provide quality health care to hundreds of thousands of low-income hoosiers. and it worked. as c.m.s. administrator, seema will have the ability to use her extensive experience to help other states achieve what we have in indiana, better health outcomes for our most vulnerable. i look forward to working with her. i thank you, sir. senator hatch: well, thanks to both of you, senators. it's a real honor for the
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committee to have both of you come, and i know ms. verma really appreciates it. we know you're busy so we'll let you go. ms. verma, we are now going to turn to you for your comments and your feelings on this nomination and then we'll turn to questions from the senators up here. ms. verma: good morning, chairman hatch and ranking member wyden. i appreciate and am grateful for your consideration of the nomination by president trump to be the administrator for the centers for medicare and medicaid services. and i thank you for the time that many of you have spent with me in advance of the hearing. and i appreciate hearing about your priorities. before i begin my statement, i would like to take a moment to introduce my family. with me today are my parents, mr. and mrs. verma, and my husband and two kids, maya and shawn. and the rest of my family and
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friends that are here with me, i really appreciate it. thank you. i've often been asked by my family and my friends as well as many members of this committee, why would i be interested in this job? i was honored and humbled and accepted president trump's call to service because i understand what is at stake. i have never stood on the sidelines of our nation's health care debate, merely pointing out what is wrong with our health care system. more than 20 years ago when i graduated from college, i started my career working on national policy on behalf of people with h.i.v. and aids as well as for low-income mothers to improve birth outcomes. i fought for coverage, greater health care access and for improving the quality of care and have continued to fight for these issues for the past 20 years. but i am deeply concerned about the state of our health care system as there's frustration
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all around. many americans are not getting the care that they need, and we have a long way to go in improving the health status of americans. doctors are increasingly frustrated by the number of costly and time-consuming burdens. health care continues to grow more and more expensive, and the american people are tired of partisan politics. they just want their health care system to be fixed. and i know this not simply because i worked in health care but because of how intimateliest it's affected my own personal life. my mother is a breast cancer survivor. due to early diagnosis and treatment. and a few years back my neighbor aiden was diagnosed with a stage 4 blass tomah. he was only 4 years old. a large tumor was growing maybe since he was born and it was wrapped around his kidney. aiden went through excruciating
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radioiation, chemotherapy, stem cell therapy, all experimental. this year aiden will celebrate his 12th birthday and both my mom and aiden are testaments to the grace of god and the ingenuity of the american health care system. this is why people travel from all across the world to get care in the united states. i want to be part of the solution, making sure that the health care system works for all americans. to families like my own and aiden's have the care that they need. i want to be able to look my children in the eye and tell them that i did my part to serve my country and to have a voice for people that don't often have one. this is a formidable challenge, but i am no changer to achieving success under difficult circumstances. my father left his entire family to emigrate to the
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united states during the 1960's and pursued four degrees while working to earn money. on my mother's side, my grandmother was married at the age of 17 with no more than a fifth grade education, but my mother went on to be the first woman in her family to finish a masters degree. my parents made a lot of sacrifices along the way to provide me with the opportunities that they didn't have and taught me the value of hard work and determination. i'm extremely humbled as a first generation american to be sitting before this committee after being nominated by the president of the united states. it is a testament to the fact that the american dream is very much alive for those willing to work for it. and it is my dream and my passion to work on the front lines of health care to improve our system. throughout my career i have
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brought people together from all sides of the political spectrum to forge solutions that worked for everyone. one of my proudest moments in my career was watching the indiana legislature pass the healthy indiana plan, which is a program for the uninsured with a bipartisan vote. c.m.s. is a $1 trillion agency and covers over 100 million people, many of whom are amongst our nation's most vulnerable citizens, providing high-quality, accessible health care for these americans isn't just a luxury. it's a necessity and often a matter of life and death. should i be confirmed, i will work with c.m.s. team to ensure that the programs are focused on achieving positive health outcomes and improve the health of the people that we serve. to achieve this goal -- >> we're going to break away

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