Capitol Correspondence - 12.03.19

HHS Secretary and CMS Feud Over ACA, Anti-Kickback Regulations

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ANCOR is sharing this “behind the scenes” article by Politico Pulse because it shows the political climate in which key health care issues are being addressed. Two of the issues mentioned below are relevant to the disability community: The Affordable Care Act (ACA) offers important protections for people with intellectual / developmental disabilities (I/DD), whom insurance companies consider as having pre-existing conditions. The Stark Rule contains important anti-kickback provisions that govern disability supports.

As reported in Politico Pulse:

“AZAR-VERMA FIGHT SPLITTING THE HEALTH DEPARTMENT – The two leaders have sparred over big policies and smaller personnel decisions, more than a dozen officials told POLITICO’s Rachana Pradhan, Adam Cancryn and Dan Diamond. The increasingly bitter personal rivalry has sparked multiple flashpoints, including:

The fight over an Obamacare replacement. Verma was deputized by the White House to craft a replacement — but came back with a $1 trillion proposal this summer that would have boosted subsidies for Obamacare plans. Azar worked to kill the idea before the president could learn about it, three officials told POLITICO.

“Verma slow-rolled writing a replacement plan and took six months,” a senior administration official said. “When it went to the White House everyone — including on up to the vice president — was aghast at the plan because of the price tag and because it propped up Obamacare.” CMS and the White House have defended Verma’s role; HHS declined comment.

The fight over seats on Air Force One. Several days before Trump announced a Medicare executive order in Florida, Verma was told that she didn’t have a seat aboard the president’s plane after the administration was forced to switch to a smaller plane; meanwhile, Azar was set to be accompanied by his chief of staff, a point that led to days of contention between the two teams. Verma eventually took her complaints to the White House and got on board the plane too, six officials told POLITICO.

HHS defended the seating on Air Force One as standard procedure and told POLITICO that Azar’s chief of staff worked to get Verma on the plane.

— The fight over announcing Stark Law changes. When Azar heard that Verma was set to lead last month’s announcement, he insisted on being included, given the importance of deregulation to the president’s agenda. HHS-CMS scheduling complications spilled over for days, and the health department ended up leaning on a Minnesota-based industry association to handle logistics. But staff realized that having the industry help oversee the rollout of new industry regulations created ethical risks and scrambled to relocate the event hours before the announcement, said three individuals with knowledge of the episode.”

Note: Seema Verma is the Administrator of the Centers for Medicare and Medicaid Services (CMS), Alex Azar is the Secretary of the U.S. Department of Health and Human Services (HHS).