CMS Administrator Seema Verma ratcheted up warnings against Democrats' healthcare ideas Monday, calling "Medicare for All," single payer and any expansion of government's role as radical and dangerous for the country.
Her remarks at the Better Medicare Alliance's Medicare Advantage Summit in Washington, D.C., fell on potentially receptive ears. Medicare Advantage plans would be forced to compete against a public option and, theoretically, Medicare for All could eliminate the need for private insurers.
The remarks were unusually strong for the CMS leader. Though she has beat the party drum on plans conservatives call a dangerous step toward socialism, the breadth and specifics of her critique expanded.
"Whatever you call it — Medicare for All, single payer, or something else — what we are talking about is a complete government takeover, stripping 180 million Americans of their private health insurance and forcing them into a system where Congress and bureaucrats make decisions about their care," Verma told an audience of roughly 100 Medicare Advantage plan operators and healthcare employees.
With the 2020 presidential election looming and healthcare top of voters' minds, it makes sense that President Donald Trump's appointees are heightening the rhetoric against these plans, experts say.
"She's an appointee of the president. There's no question about who she is and what she represents," Gail Wilensky, senior fellow at global health nonprofit Project HOPE and director of Medicare and Medicaid under President George H.W. Bush, told Healthcare Dive.
Still, Wilensky said Verma is one of the more politically-oriented CMS heads she's seen. Verma worked with Vice President Mike Pence on Medicaid policy in Indiana before being nominated by Trump for the position in 2016.
"The focus right now, on some of the challenges of Medicare for All, is not surprising," Wilensky said. "You do have to be careful that you don't get political in the sense of campaign involvement in your appointment position."
Presidential appointees are allowed to participate in political activities and publicly endorse candidates, though they can't solicit direct donations to a party or nominee or receive compensation, according to the U.S. Office of Government Ethics. But CMS says Verma isn't serving any direct political purpose — merely speaking out against policies that could disrupt roughly 20% of the country's GDP.
"Why wouldn't she be talking about Medicare for All or public option?" a CMS spokesperson told Healthcare Dive. "These are proposals that would dramatically impact our healthcare system and as the head of the programs it would impact the most and in turn our beneficiaries, it makes sense for her to weigh in on the public discussion."
Democrats competing to take on Trump in the 2020 presidential election have moved further left over the past year, with Sens. Bernie Sanders, I-Vt., and Elizabeth Warren, D-Mass., supporting Medicare for All — the creation of a government-run insurance program and the elimination of private insurance entirely.
Two top-polling Democratic candidates, Sanders and ex-Vice President Joe Biden, have locked horns over healthcare in the past week. The more moderate Biden is backing a public option, an expansion of the Affordable Care Act passed on his watch under President Barack Obama in 2010, as a less disruptive alternative to Medicare for All.
A smattering of candidates (including Sanders' Medicare for All bill co-sponsors Sens. Cory Booker of New Jersey, Kamala Harris of California and Kirsten Gillibrand of New York), fall somewhere in the middle, supporting Medicare for All with preservations in place for private coverage if the patient chooses.
Voters increasingly embrace the idea as well. More than 50% of adults in a recent Kaiser Family Foundation poll said they favor national health plan.
According to the American Hospital Association and the Federation of American Hospitals, allowing citizens to opt into a government-run healthcare plan would cost hospitals $800 billion and only nominally cut the uninsured rate.
However, though the Congressional Budget Office agrees a public payer expansion will "substantially" increase federal spending, it could also potentially yield huge savings in the form of lower administrative costs and overhead. Additionally, it would reduce or eliminate employers' and employee contributions for insurance obtained through work.
Either way, health system and payer lobbies are advocating fiercely against the proposals. About 30 of the most powerful companies and associations in the industry joined together in 2018 to create the Partnership for America's Health Care Future to lobby against government-run insurance (though member group the American Medical Association only narrowly voted to reaffirm its opposition to a single-payer system earlier this year).