Biden’s Health Administrator Lists Gains, Concerns as Exit Nears

Chiquita Brooks-LaSure is counting down her final days in office after taking over as administrator of the Centers for Medicare & Medicaid Services at the height of the Covid-19 health emergency in May 2021.

Her pandemic management of the “3 M’s”—Medicare, Medicaid and the HealthCare.gov marketplace—followed the first Trump administration’s periodic questioning of science-based health policies, which challenged public trust in federal programs and institutions.

Nearly four years later, Brooks-LaSure will soon leave the CMS to a returning Trump administration whose vastly different ideas about running the nation’s largest health-care programs will test the longevity of some of the Biden administration’s most notable accomplishments.

“While it was overshadowed by broader economic concerns like inflation, the Biden administration’s achievements on health care were substantial,” Larry Levitt, executive vice president for health policy at KFF, said in a statement. But its efforts “could be fleeting if President Trump and Republicans in Congress turn back the clock.”

It’s the nature of health-care politics in Washington, where four years can produce lasting or temporary change, depending on the whims of Congress and the staying power of the policies that each administration enacts. For her part, Brooks-LaSure said she’ll exit proudly after piloting a laundry list of notable consumer-friendly initiatives into action, most designed to make health coverage more affordable.

“I hope that the incoming administration sees that and really understands that rolling back our reforms would really hurt, not just the people who are covered by them, but the entire economy,” Brooks-LaSure said in a recent interview at Department of Health and Human Services headquarters.

‘Highest Concern’

Her “highest concern” as the GOP assumes control of both Congress and the White House this month: ensuring that lawmakers renew the enhanced premium tax credits that helped nearly 24 million people sign up for coverage this year, an amount first envisioned when the Affordable Care Act became law in 2010.

“Whenever something requires action, that’s actually where you have the most concern,” Brooks-LaSure added. “They need to affirmatively extend the subsidies.”

The tax credits, part of the Democrats’ Inflation Reduction Act, helped drive the uninsured rate to an all-time low, while saving enrollees an average of $800 a year on premiums in 2024, with most qualifying for $0 premium plans.

A KFF analysis released Wednesday found 44 million people enrolled in health coverage in 2024 through ACA marketplaces and states’ expanded Medicaid eligibility. That’s roughly 1in 6 people under age 65, or 16.4%.

But Medicaid’s uncertain future with the Trump administration is concerning, Brooks-LaSure said.

If implemented, Republicans’ desire to cut program funding and expand work requirements for Medicaid enrollees could reduce the Biden administration’s coverage gains.

For example, Georgia’s Medicaid expansion has enrolled only 4,000 people out of 400,000-plus who would have been eligible if not for the state’s work requirements and the “red tape” documentation it requires, Brooks-LaSure said.

Lowering Drug Costs

Concerns aside, Brooks-LaSure expressed pride on the administration’s efforts to lower Medicare prescription drug costs through price negotiations, leading the beleaguered health-care industry through the Covid-19 pandemic, establishing mandatory staffing requirements for nursing homes, working to protect access to contraception, and embedding health-care equity provisions in numerous regulations to help reduce health disparities.

“When I looked at it, I was blown away by how much we’ve been able to do,” Brooks-LaSure said.

“I feel really good about the work that we have done. I feel like we left it all in the field. I am so proud of what we have accomplished.”

Levitt called the first-ever Medicare drug price negotiations under the Inflation Reduction Act a “momentous political victory over the powerful pharmaceutical industry.”

Team Biden also “helped limit Medicare beneficiaries’ costs by passing a $2,000 cap on their annual out-of-pocket spending on Part D drugs, and successfully enshrined in law a $35 monthly cap on what they pay for insulin,” Levitt said.

After months of talking with nursing home residents, staff, industry representatives and state officials, Brooks-LaSure said she believes that if federal nursing home funds were spent and invested wisely, the CMS staffing mandates could be achieved, despite industry claims to the contrary. The Biden administration has moved to make nursing home funding and complicated ownership structures more transparent.

“We have to grapple as a country with how much we’re spending on long-term care,” she said. “We see Medicaid as the primary payer, and I think there are issues with that.”

Advice for Successor

Brooks-LaSure provided no clues on her future plans after she leaves the CMS. But she offered a bit of advice for her presumed successor, Mehmet Oz: Always be mindful of how CMS decisions will affect the estimated 160 million people covered by Medicare, Medicaid, and marketplace coverage, and how CMS policies affect the providers who treat these people.

“There are so many rules that CMS has, for multiple reasons. So it can be really easy to look at so many of the other factors,” Brooks-LaSure said. “You have to make sure that you’re looking at ‘how is this going to affect people and providers’ and ‘is this the result that I want?’ And if it’s not, ‘let’s go back and see if we can get a different answer.’”

More often than not, she added, “if you really push, you can get to a better result.”