SAN FRANCISCO – Stepping into the land of the Trump resistance, Seema Verma flatly rejected California's pursuit of single-payer healthcare as unworkable and dismissed the Affordable Care Act as too flawed to ever succeed.
Speaking Wednesday at the Commonwealth Club here, the administrator of the Centers for Medicare & Medicaid Services said she supports granting states flexibility on health care but indicated she'd not give California the leeway it might have to spend federal money on a single-payer system.
“I think many of the analysis has shown it's unaffordable,” Verma said throughout a question-and-answer session following her speech. “It doesn't make sense for us down the sink time on something that isn't going to work.”
During her speech, Verma issued a broader warning to advocates pushing for a Medicare-for-all program nationally. She asserted “socialized” approach to medicine would endanger this program and the health care it offers for countless older Americans.
“We don't wish to divert the reason and focus away from our seniors,” Verma said within the address before more than 200 people. “In essence, Medicare for all would become Medicare for none.”
Single-payer has emerged as a key issue in the California governor's race this season. The current front-runner for governor, Gavin Newsom, a Democrat and the current lieutenant governor, has vowed to pursue a state-run, single-payer system for all Californians if elected in November. Many California lawmakers have endorsed that concept as the next step toward achieving universal coverage and to tackling rising costs.
California has enthusiastically embraced the Affordable Care Act, assuring leaders have struggled with – as well as bucked – the Trump administration on a number of health-policy fronts. The state stands to lose a lot more than every other if the Trump administration works in further dismantling the ACA.
About 1.4 million Californians buy coverage through the state's Obamacare exchange, Covered California, and over 3 million have joined Medicaid as a result of the program's expansion underneath the law.
Verma wields enormous power as head of CMS, overseeing a $1 trillion budget. The agency sets policy for Medicare, Medicaid and also the federal insurance exchanges under the ACA.
The landmark health law, she said, was so flawed it couldn't work without further action from Congress.
“It wasn't working when we came into office and it continues not to work,” Verma said, answering a question from moderator Mark Zitter, founding father of the Zetema Project, a nonprofit organization that promotes debate on healthcare across partisan lines. “The program is not designed to be successful.”
Zitter billed the event as a rare opportunity for Californians to hear directly from a high Trump administration official, although Verma’s remarks broke little new ground, he said.
Trump healthcare policies figure into a lot of California's congressional races this fall by which incumbent Republicans are fending off Democratic challengers. And in court, California Attorney General Xavier Becerra is leading a coalition of attorneys general who are defending the constitutionality of the ACA in a Texas case with national implications.
The Trump administration has sided with the officials waging the lawsuit, choosing to not defend the law's protections for those who have preexisting conditions. Separately, the administration has backed work requirements for most people on Medicaid.
California's state Senate passed legislation in May banning such requirements like a condition for eligibility in Medi-Cal, the state's Medicaid program. The balance is pending in the state Assembly.
“Making medical health insurance coverage determined by work requirements is the opposite of all we've helped within California,” state Sen. Ed Hernandez (D-West Covina), author of SB 1108, said in May.
State lawmakers also are considering bills that would limit the GOP-backed sale of short-term health policies and stop people from joining association health plans that don't have robust consumer protections.
In a job interview after the speech, Verma criticized those legislative efforts in California because they would limit consumer choice.
“Any efforts to thwart choice and competition and letting Americans make decisions regarding their health care isn't good health policy,” she said.
Peter Lee, executive director of Covered California, the state's ACA marketplace, has criticized the Trump administration for promoting those cheaper, skimpier policies as an alternative to ACA-compliant plans. He said he fears consumers is going to be harmed by “bait-and-switch products” that do not provide comprehensive benefits.
“There happen to be a number of policies from Washington which have the effect of raising costs, particularly for middle-class Americans, and pricing them out of coverage,” Lee said in an interview a week ago. “This is not a failure of the ACA. This really is entirely happening since the new administration.”
Most of Verma's speech in Bay area centered on Medicare. She outlined a number of initiatives made to strengthen this program and protect taxpayers from ballooning costs. After the speech, CMS announced proposed changes to Medicare payment policies for outpatient care that could yield savings for that government and patients.
In her remarks, Verma reiterated the Trump administration's efforts to lessen prescription medication prices, improve patients' use of their very own medical records and eliminate burdensome regulations on doctors and other medical providers.
Verma received a polite round of applause at the beginning and end of her appearance.