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News India Times January 17, 2020 4 Cover Story Affordable Healthcare – that’s all you need to know Administrator of the Centers for Medicare and Medicaid Seema Verma, discusses the design and delivery of two of the nation's biggest medical programs By Sarah Varney | Kaiser Health News eema Verma, administrator for the Centers for Medicare &Medicaid Services, sat down for a rare one-on-one interview with Kaiser Health News senior correspondent SarahVarney. They discussed her views on President Donald Trump’s plan for sustaining public health insurance pro- grams, how the administration would respond if Obamacare is struck down by the courts in the future and her thoughts on how the latest “Medicare for All” proposals would affect innovation and access to care. A portion of their conversation aired on PBS NewsHour on Dec. 23. A transcript follows, edited for length and clari- ty. SarahVarney: Thank you, Administrator Verma, for join- ing us.We really appreciate it. You spoke recently about this need to protect Medicaid as a lifeline, but also not to have people be entrapped, or trapped on, Medicaid and come to rely upon it too greatly. So, as I was mentioning, we were in Tennessee recently, and I know you can’t speak to specific cases — Seema Verma: Mmm, hmm. Varney: But, we did find a number of families who had been disenrolled, and then found it quite difficult to get back on. And I just wondered if there is a danger in taking this approach where there’s more frequent verification checks, a real focus on eligibility verification, that it could discourage some parents and kids who might be eligible for the program from signing up? Verma: Well, our top priority is making sure that the beneficiaries in the Medicaid program have high-quality, accessible care, and we want to do everything that we can to improve the quality of their lives. In terms of the enroll- ment process, we also have an obligation to taxpayers to make sure that only the people that qualify for the pro- grams are participating. And we also want to make sure that the programs are sustainable over the long term. I think there’s a balance between making sure it’s easy for people to apply, but we also have to make sure that we do the appropriate work to make sure that they qualify for the programs. Varney: So, are you concerned, though, that there were a number of people, after the eligibility process kicked in again in 2017, after the ACA sort of put things on hold for a while, that there might have been families, though, that have been lost? That just don’t want to come back, or can’t come back? Or are hearing worries about the public charge rule, as well, and so are concerned about giving the govern- ment their information? Verma: You know, our top priority is making sure that we focus on improving quality of care, high-quality care, acces- sible care, and making sure that we’re improving the quality of life for individuals. You know, when I think of the Medicaid program, and in every decision we make, I try to keep in mind the actual beneficiary. In my time spent on the Medicaid program, I’ve met a lot of Medicaid benefici- aries. I met a gentleman, Richard, who was in Indiana. He was a quadriplegic and literally requires 24-hour care. I met some parents of a child on the Medicaid program. This child had cerebral palsy and so severe that they require 24- hour care, and you can imagine the impact on the entire family. This is a child that will never be independent, will always require help. And so, when we’re creating our eligi- bility policies, we keep those individuals in mind.We don’t want to make it harder for them to apply for the program. And so, we try to come up with policies that don’t put a lot of onerous requirements on the beneficiary, but we can have requirements for states that require them to do back- end processes, and back-end checks that don’t actually burden the actual recipient or their families, but that also ensure that we are putting the appropriate protections in place for taxpayers, so the program is sustainable over the long term. And we have only the people that qualify for the program participating. Varney: We know that more health coverage leads to longer life expectancy; I think this has been well estab- lished. And I wonder if whether or not the administration should be emphasizing more finding those children who are not enrolled, who are eligible but not enrolled, and per- haps focusing on outreach, which we haven’t really heard your administration talk about? Verma: Well, again. Our focus is on making sure, espe- cially children, that they have access to high-quality health care. As a mom, I’ve got two kids, so I can personally attest to the fact that having health insurance is very important for children. Something very little, like an ear infection, can lead to deafness if it’s not, you know, treated appropriately. So having that access to high-quality health care is very, very important to their development. The Trump adminis- tration is very committed to the Children’s Health Insurance Program; the president signed legislation around that. Additionally, we have spent over $48 million on out- reach efforts.We’re very focused on working with states, so that they can identify the best practices to make sure that those individuals, children that qualify, can enroll in the program, that they’re aware that this program exists. Varney: Have you found that the reduction in the Navigator grants has made it more difficult to reach those families? Verma: We, actually, we have not. If you look, the Navigator programs are really aimed at the Affordable Care Act programs and the exchange programs. So those are not aimed at children. Those are aimed at our adult popula- tion. And we have seen very minimal impact.What we have done is try to increase our digital communication, of, to help enrollment. And we’ve seen a very minimal impact on enrollment. I think the issue around enrollment really comes back to affordability. Obamacare has had a direct impact on increasing premiums. Across the nation, we’ve seen premi- ums go up by 100%, 200%. [Editor’s note: PolitiFact rated this claim by the Trump administration “false.” ACA premi- ums were down by about 4 % in 2019 compared with 2018.] And so the issue around enrollment is that health insur- ance has become so unaffordable for families that that’s why they can’t afford their coverage. Varney: So we did hear from a number of federally quali- fied health centers that although the Navigator grants really were focused on, you know, ideally they were focused on exchanges, people buying private health insurance, that, in fact, there were a lot of people who came in, who became eligible for Medicaid and discovered that they were eligible for Medicaid in that way. So I wonder if there is additional outreach that needs to be done to those families, not just virtually or online, but some other way to reach those fami- lies? Verma: The real problem around making sure that peo- ple have access to affordable coverage is really addressing the high cost of health care. And that’s what the president is focused on. His health care agenda isn’t just about putting out more subsidies and having the government pay more and more and creating unaffordable programs. But it is about addressing the underlying cost drivers in health care. That’s why he’s focused on prescription drug pricing, he’s focused on transparency, price transparency, so that there’s more competition in the market.We’re also focused on get- ting rid of burdensome regulations that we know drive up the cost of care. I think by addressing that, that is going to result in decreased premiums, which will result in more people hav- ing access to affordable coverage. Varney: But all those things that you just mentioned — they don’t necessarily affect the Medicaid population directly. Now, they may affect them indirectly by increasing overall health care costs, but in terms of the Medicaid pop- ulation, really reaching out, ensuring that every single child who’s eligible for Medicaid is enrolled? Verma: So, our focus is also on addressing the economy. Under the president’s leadership, we have a booming econ- omy.We have one of the lowest unemployment rates.We have more people that are earning more money, and we have fewer people living in poverty. There’s been a reduc- tion in the number of people living in poverty by 1.4 mil- lion people. And so, we are seeing people coming out of the Medicaid program, and because the economy’s doing so well. The issue is, though, they can’t afford coverage. And so, even as we increase our outreach efforts, we spent over $48 million on outreach, the issue is around affordability. Obamacare has impacted the market in such a way that it’s become unaffordable for people that don’t have subsidies. Varney: So, we’re at this moment in our country and our national conversation where we’re talking about how do we ensure that more and more people are insured? And I won- der what the administration is doing to move the needle, to stop the growth in the uninsured, particularly among chil- dren? Verma: I think our focus has been about addressing Photo courtesyKaiser Health News Seema Verma, left, administrator of the Centers for Medicare and Medicaid, sitting for an interview with Sarah Varney of Kaiser Health News Jan. 3, 2020. Continued On Page 5 S