Chiquita Brooks-LaSure testifies earlier than the Senate Finance Committee throughout her nomination listening to to be administrator of the Centers for Medicare & Medicaid Services in Washington on Thursday, April 15, 2021.
Caroline Brehman | CQ-Roll Call, Inc. | Getty Images
In her first yr as administrator of the Centers for Medicare and Medicaid Services, Chiquita Brooks-Lasure has overseen the growth of presidency well being protection to a report variety of Americans beneath Medicare, Medicaid and personal Affordable Care Act alternate plans.
Now, she needs to maintain them insured.
“We cover over 150 million people as a result of all of the hard work of the agency really enrolling people in coverage. So, we are a huge payer, and we help dictate coverage in this country … and have a powerful opportunity to advance health equity,” Brooks-Lasure mentioned.
In the yr forward, one of many company’s largest challenges can be to create a clean transition for thousands and thousands of Medicaid members who may lose protection when the Covid public well being emergency ends. Under the federal well being emergency, states have put eligibility redeterminations on maintain for the final two years.
Loss of protection
While the administration is anticipated to resume the present emergency designation subsequent month, a Kaiser Family Foundation research estimated that between 5 million and 14 million folks might be disenrolled when redeterminations resume.
Brooks-Lasure says well being insurers that administer state Medicaid applications will play an vital function to assist those that lose eligibility to transition to non-public alternate well being plans, or Medicare in the event that they’ve turned 65.
“We have more plan participation, particularly in Medicaid coverage, than we did, say, 10 years ago. So they are a key component to helping make sure that we — and by we, I also mean the states — move people to whatever type of coverage they are eligible for,” she mentioned.
Even past the general public well being emergency, she needs well being protection to be extra constant throughout private and non-private applications.
“Because whether it’s talking about maternal health or you’re in the middle of cancer treatment … you want to stay focused on the condition itself rather than having to worry about what changed in your coverage,” she mentioned.
In a brand new report outlining priorities for the company, Brooks-Lasure says addressing well being disparities is a central pillar of the company’s mission. It’s been particularly centered on enhancing maternal well being protection; Medicaid applications now cowl 40% of births within the U.S. With funding from the American Rescue Plan Act, handed in 2021, the company is working with states to increase Medicaid protection for brand spanking new moms who’re uninsured from 60 days to 12 months.
When it involves reproductive care, Brooks-Lasure mentioned CMS will even prioritize enhancing entry to contraception in Medicaid and ACA well being plans within the yr forward. If the Supreme Court overturns Roe v. Wade, as anticipated this month, the company can be restricted in its means to offer entry to abortion for ladies on Medicaid beneath federal funding guidelines.
Brooks-Lasure mentioned the company was centered on areas it has authority over, equivalent to preventative care and contraception. She mentioned CMS is encouraging states to make use of Medicaid to make sure women and men have entry to contraception, “in light of whatever the Supreme Court decision is regarding broader services.”
Medicare premium rollback
One of the most important choices CMS issued this yr was to restrict Medicare protection for the Alzheimer’s remedy Aduhelm, after blended information on the drug’s efficacy. However, the transfer got here after actuaries had factored within the anticipated excessive price of the drug into 2022 Medicare premiums. Medicare recipients can anticipate a rollback in 2023.
“Because coverage is lower, we are going to incorporate that in the premium for next year,” Brooks-Lasure mentioned.
Medicare recipients may additionally get a break on drug plan premiums with the introduction of a number of biosimilar variations of AbbVie’s high-priced arthritis remedy Humira over the following yr. Humira gross sales topped $20 billion in 2021. Amgen’s biosimilar model would be the first to go on sale within the U.S., in January.
Brooks-Lasure mentioned CMS actuaries are calculating the potential influence of the transition to Humira biosimilars and are anticipated to launch their evaluation in early September, in time for setting 2023 premiums.