Seema Verma, the former administrator of the Centers for Medicare and Medicaid Services under President Donald Trump discussed the agency’s response to COVID-19 and shared details about the negotiations over Tennessee’s Medicaid waiver during a recent discussion with the Vanderbilt University Medical Center Department of Health Policy.
Verma was the keynote guest for the Department’s biannual Research Into Policy and Practice Lecture Series on Jan. 24, which covered a range of topics focused on her time leading one of the federal government’s largest public health agencies.
"CMS essentially had a de novo pandemic response to COVID-19," Verma said.
According to Verma, there was only a 25-page document that included no specific pandemic preparation plans regarding telehealth, rules waivers and other rules governing hospital operations that might have needed to be suspended or waived to allow appropriate response.
The ranging discussion with Associate Professor of Health Policy John Graves, PhD, covered a variety of topics beyond the pandemic, including Medicaid’s current waiver process, which Verma described as a “mother may I” structure, “where states constantly have to ask permission to tailor their programs to their specific conditions,” she said.
This was part of the driving force behind Tennessee’s interest and later negotiation with CMS about restructuring Tenncare to be funded by a per capita cap, Verma said, which has become more commonly described as a “block grant.”
Verma said she favors this type of reform because it gives states “more flexibility” to tailor their programs to their specific populations and limit the responses states must provide to CMS inquiries.
She also hopes Congress will codify processes and requirements on how waivers are rescinded similar to how they are approved. She hopes in the future that waivers are only rescinded based on cost or quality measures, and not for what she characterized as “arbitrary” reasons.
Verma said her time at CMS, which covered 2017 to 2021 and made her the longest tenured administrator to date, was focused on four primary objectives: promoting competition among insurers, encourage innovation, support value-based care and supporting market-based solutions.
One of the market-based solutions she referenced was the market-driven aspect of Medicare’s managed care plans, where enrollees can “fire” their insurer if they don’t like their plan, which would be contrary to a nationalized, single-payer system more progressive policy proposals have called for.
Verma also said health disparities in non-expansion states should be addressed by tying reimbursement to whether hospitals and insurers can document how they are identifying and reducing health disparities.
Assistant Professor of Health Policy Kevin Griffith, PhD, contributed to this report.