High drug prices come first. Lack of staff. Too few hearing rooms. Democrats have plenty of reasons for not calling the head of Medicare and Medicaid up to Capitol Hill to testify yet, but advocates say it’s time to get started.
Democrats have regularly called out Centers for Medicare & Medicaid Services Administrator Seema Verma for the way she has run the two federal health programs, work requirement programs for Medicaid she approved in nine states, and how she changed implementation of the Affordable Care Act. However, she hasn’t been asked to testify before any House committees since Democrats took control in January.
Pressure to review her work ramped up when it was reported that Verma had directed millions of taxpayer dollars toward outside communications consultants to bolster her profile.
Leaders of the House Energy and Commerce and Ways and Means committees told Bloomberg Law that they will ask Verma to testify at some point. House Energy and Commerce Committee Chairman
For her part, Verma said she’s willing and ready.
“We’re always in constant communication with Congress,” Verma told Bloomberg Law. “There are always requests around technical assistance if they’re working on certain legislation. I try to make sure I’m available to any member of Congress if they have questions and comments. If there is an invitation to testify, we’ll obviously do that.”
Time for Oversight
Health-care advocates at Families USA, Protect Our Care, and Public Citizen said the invitation should be forthcoming. They want Democrats to start conducting more oversight of the CMS now that they’ve passed some health-care legislation.
“It’s time to turn up the heat on oversight,” Brad Woodhouse, executive director of Protect Our Care, said in an interview. Verma and HHS Secretary Alex Azar have “not been held accountable” and need to be, he said.
Eliot Fishman, senior director of health policy at Families USA, said he will be concerned if Verma is not brought in before the end of 2019.
Verma testified twice during the last session of Congress, once before the Senate Finance Committee for her confirmation as CMS administrator and once before the Senate Homeland Security and Governmental Affairs Committee on combating Medicaid fraud.
Lack of Resources
Committees have limited resources, which includes staff, and that means they have to prioritize what issues they focus on, a former congressional oversight staffer said on condition of anonymity. Democrats on both the House Energy and Commerce and Ways and Means Committees have hired new staff, but it’s still not a large increase from what they had while in the minority.
The House Energy and Commerce Health subcommittee hasn’t asked Verma to testify because of a lack of committee rooms and staff, Chairwoman Anna Eshoo (D-Calif.) said in an interview. The committee only has two hearing rooms and six subcommittees vying for them, she said.
It also takes time to put together witnesses to testify and the subcommittee only has so much staff, Eshoo added.
“I could have hearings every morning, every afternoon, five days a week,” Eshoo said, adding that she has been pushing to hold more hearings, even going so far as to ask if she can hold hearings in other rooms.
That doesn’t mean that staff can’t be working on legislating and oversight of CMS at the same time, Eshoo said.
The House Energy and Commerce Oversight subcommittee Chairwoman Diana DeGette (D-Colo.) also said the shutdown prevented committees from starting their work until the end of January, which has left CMS oversight lagging.
The CMS also has limited resources, the former oversight staffer said. Those same CMS staff who help Congress with legislation could be the same people who prepare for an oversight hearing.
After Congress decides it has finished with addressing the high cost of prescription drug prices, that could free up more resources to do more oversight, including at the CMS, the former oversight staffer said.
Not the Top Priority
Getting any administration official to testify takes time and effort, and Democrats likely want to focus on passing bills first, the former oversight staffer said.
Lawmakers have the backing of liberal advocacy groups who see health-care legislation as their top priority as well. Fishman, Woodhouse, and Eagan Kemp, a health-care policy advocate at Public Citizen, all said legislating is their top priority. Woodhouse calls oversight a close second.
“I don’t view it as urgent that she come,” House Ways and Means Health subcommittee Chairman
The majority of the health-care legislation Congress is passing would be implemented through systems that Verma manages at the CMS.
Doggett said he will likely ask Verma to testify about recommendations made by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare policy, but that it won’t be immediately because of other priorities like appropriations and infrastructure.
There are enough issues in health care, both in policy and ethics, for years’ worth of hearings, a health policy consultant familiar with Democrats’ oversight agenda said. House Democrats need to focus on health-care sabotage overall, not just that of the ACA, the consultant added.
Steps Toward Oversight
House committees with jurisdiction over health care have taken important first steps with oversight by sending out a variety of document requests, and it’s a sign they could be gearing up for more CMS oversight, Maura Calsyn, managing director of health policy at the left-learning Center for American Progress, said.
The two committees have sent out at least four letters to the CMS requesting documents on transparency from the Centers for Medicare & Medicaid Innovation, antipsychotic prescribing in nursing homes, and ACA user fees. They’ve also sent at least five document requests to the Department of Health and Human Services.
Typically an oversight hearing doesn’t happen until staff has spent time developing an argument or coming up with specific questions for a specific official, the former oversight staffer said.
— With assistance from Tony Pugh