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Verma Takes Heat at House Hearing on ACA 'Sabotage'

Analysis  |  By MedPage Today  
   October 24, 2019

House oversight subcommittee doesn't hold back with criticism of CMS administrator.

This article was first published on Wednesday, October 23, 2019 in MedPage Today.

By Washington Correspondent

WASHINGTON -- CMS Administrator Seema Verma faced serious castigation in her first appearance before the Democrat-led House.

The Wednesday hearing of an oversight subcommittee for the House Committee on Energy & Commerce, entitled "Sabotage: The Trump Administration's Attack on Healthcare," also saw the agency's leader respond to questions with answers that were short on details.

In her opening remarks, committee chair Diana DeGette (D-Colo.) stated that President Trump has been trying to "dismantle" the Affordable Care Act since he took office, and took Verma to task for supporting those efforts.

DeGette pointed out that under the Trump administration, and for the first time since the passage of the ACA, the number of uninsured in the U.S. has actually gone up: "About 1.9 million more people were uninsured last year compared to the year before, including nearly half a million more children," she said.

DeGette blamed the losses on the administration's constant efforts to chip away at the ACA, including an executive order attempt to repeal the ACA; encouragement of the growth of less comprehensive insurance plans that leave patients "on the hook" when they need coverage most; and support of a lawsuit seeking to erase the entire law.

While Republicans pointed out that average premiums on the ACA exchanges are expected to drop next year by 4%, DeGette cited a study from the Kaiser Family Foundation that found health insurance premiums are 16% higher this year than they would have been if the Trump administration had not repeatedly tried to weaken the ACA.

DeGette also attacked the Trump administration's role in the Texas vs. United States lawsuit -- brought by Republican states and seeking to overturn the entire ACA -- which the Justice Department pointedly decided not to defend. If the appeals court rules the way the administration wishes, the ACA would become void and about 21 million people would lose their health insurance, DeGette said.

Verma was asked if that 21 million figure was accurate. She said "no," but did not offer her own estimate of how many people would potentially lose coverage.

Instead, she repeatedly stressed that the president has said he will have an alternative plan if the ACA is invalidated.

When DeGette pointed out that people with pre-existing conditions would also lose their health insurance if the ACA was repealed, Verma said "we will do everything we can" for people with pre-existing conditions.

She also argued that even with the ACA intact, there are people who lack protections: "If you can't afford health insurance, and you have a pre-existing condition, then you don't have protections."

DeGette continued to hammer Verma for more information on the administration's fallback plan if the ACA was repealed. "My question is, do you have a copy of the plan that will replace the ACA, yes or no?" DeGette asked bluntly.

Verma said she would not "get into any specifics." DeGette cut Verma off and yielded the floor to the next member of the committee.

Ranking member Rep. Brett Guthrie (R-Ky.) then gave Verma time to complete her answer.

Once again, Verma argued that people with pre-existing conditions do not have any real protections for their conditions if their only option is to pay a third to half of their income for health insurance.

"What we're focused on is lowering the cost of healthcare" she said, touting several of the agency's efforts to reduce administrative burden, and increase efficiencies, so that more people can afford healthcare.

Other Democrats criticized Verma for her role in those CMS efforts, such as approving and encouraging Medicaid work requirements; expanding short-term limited duration plans (sometimes called "junk plans"); and crippling the ACA enrollment by shrinking the sign-up period, cutting the ACA advertising budget, and slashing funding for health exchange navigators.

With regard to the latter, Republicans, including Michael Burgess, MD (R-Texas), argued that the ACA navigators have been much less effective than brokers.

Verma agreed. "We found the navigator programs weren't meeting their goals," she said, adding that, at times, it was costing $5,000 to $7,000 to enroll a single person in the ACA exchange.

Rep. Joe Kennedy (D-Mass.) ripped into Verma for claiming that work requirements would make people healthier, or bring them out of poverty. He noted that over 18,000 people lost health insurance in Arkansas after work requirements were enacted, as would have nearly 17,000 in New Hampshire (if the state's governor had not delayed the changes or a federal judge had not blocked them). Most of those people were working or eligible for exemptions, he said.

Kennedy cited a New England Journal of Medicine study that found that lack-of-insurance rates increased in Arkansas without an increase employment, and asked Verma to point him to a single study that proves Medicaid work requirements make people healthier.

Verma replied that "numerous" studies show "employment has a positive impact on health outcomes," but Kennedy was not buying it.

"You guys run healthcare programs in this country," he said. "I am certain you understand the difference between correlation and causation."

Verma said that she's spoken to many people living in poverty around the country, and "they want to find a pathway out of poverty."

"I'll take that as a 'no,'" Kennedy retorted.

“Healthier people might work; work doesn't necessarily make people healthier. You are imposing policies on millions of people across this country -- can you show me one study that says that that is a good policy?”


Committee chair Diana DeGette (D-Colo.) took Verma to task for supporting President Trump's efforts to dismantle the ACA.

Other Democrats criticized Verma for her role in CMS efforts to implement Medicaid work requirements, expanding short-term limited duration plans, and cripple ACA enrollment by shrinking the sign-up period, cutting the advertising budget, and slashing funding for health exchange navigators.

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