[co-author: Josue Silva]
On February 17, 2021, it was reported that President Biden would nominate Chiquita Brooks-LaSure as Administrator of the Centers for Medicare & Medicaid Services (CMS), the largest operating division of the U.S. Department of Health and Human Services (HHS).
The CMS Administrator enjoys considerable influence. Administrator-designate Brooks-LaSure, if confirmed, will run the largest HHS operating division with more than $1 trillion in annual expenditures, more than 6,000 employees, 10 offices around the country, regulatory oversight of nearly all health care providers in the nation and control of federal health programs covering 145 million Americans, including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA) marketplaces. Because of this role, the Administrator and her actions often have wide-reaching effects on health care, even beyond the programs CMS administers.
long supported. she has been an advocate for medicare for all for over a year. she has been supportive for a number of other proposals. medicaid buy-in. a lot of different options. democrats would definitely help themselves if they rebranded this and gave themselves a little more room. democrats have a better argument to make on what they will do on melt care. medicare for all, that may not be their first preference. they may like single payer better. that s something all of the democrats could help themselves in the general election. here is what they do to help themselves, explain where they will get a trillion dollars a year, $1 trillion. i don t know how many it is. we ll raise taxes by a trillion dollars a year. if he is held to that standard he can explain how he can pay for the high income tax cut. it will be the standard. they will say we will give you
these are belter off people. than worse off people. they probably get more press attention. and the press kind of naturally gravitates to stories of things going wrong. people facing problems. you don t, you are not hearing anything at all about all of the governors who are depriving five to six million people, medicaid, by not going for the medicaid buy in, the medicaid expansion. and i think there is a little lesson here that all the people are signing up for medicaid. yes as professor gruber said it its free. also a lot simpler than trying to have subsidies in a complicated insurance market. the politics of defending complex legislation is never seas. remember what these democrats are worried about is losing an election next year. to a republican who will then replace them, and not just vote for the correction to the bill. they will be more votes to actually completely real, repeal
so i think that s quite different from the medicaid buy-in, where i think they re totally wrong. if they go down this route, they re making a terrible mistake. they re empowering the federal government to run the exchanges. what s the downside for a consumer in states where they reject the funding when it comes to medicaid? if the federal government does its job under the bill, there may not be a down side as long as the federal government organizes the exchanges. i have a hunch if some states say this is a terrible idea, we re getting pressure, we want our people to join this market oriented system, maybe they ll give them some time to develop it. but i think in the end, having a strong federal exchange could be the best thing that happens. there s a difference between the exchange and the medicaid expansion. as far as medicaid is concerned, if a state decides not to expand
want interstate purchasing of insurance, but they don t want a national system with decent rules that protect consumers. so i think that s quite different from the medicaid buy-in, where i think they re totally wrong. if they go down this route, they re making a terrible mistake. they re empowering the federal government to run the exchanges. what s the downside for a consumer in states where they reject the funding when it comes to medicaid? if the federal government does its job under the bill, there may not be a down side as long as the federal government organizes the exchanges. i have a hunch if some states say this is a terrible idea, we re getting pressure, we want our people to join this market oriented system, maybe they ll give them some time to develop it. but i think in the end, having a strong federal exchange could be the best thing that happens.