RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.

Biden reportedly will nominate Chiquita Brooks-LaSure to oversee CMS

Although he is yet to make a formal announcement, media outlets report that President Joe Biden will name Chiquita Brooks-LaSure to oversee the Centers for Medicare & Medicaid Services (CMS).

 Brooks-LaSure previously served under the Obama administration, playing a key role in guiding the Affordable Care Act through passage and implementation. Her previous positions in the federal government include deputy director of policy at the Center for Consumer Information and Insurance Oversight within CMS and director of coverage policy at the Department of Health & Human Services.

The Washington Post first reported the news and the upcoming announcement has been picked up by several media outlets. If the Senate confirms her nomination, Brooks-LaSure will become the first Black woman to lead CMS.

Brooks-LaSure most recently served as the managing director of Manatt Health before leading Biden’s review team of the Department of Health & Human Services, helping to assess the Trump administration’s operations.

Biden’s Justice Department formally changes position on ACA Supreme Court case

The Biden administration this month sent a letter to the U.S. Supreme Court, formally changing the government’s position on the constitutionality of the Affordable Care Act (ACA). The former Trump administration had pushed to dismantle the ACA, saying that the health care reform law was no longer constitutional since Congress passed the tax overhaul in 2017 that eliminated the individual mandate that required individuals to obtain health insurance or pay a penalty. The Supreme Court heard oral arguments over the constitutionality of the law on November 10, a week after the Presidential election.

But in the Feb. 10 letter to the Supreme Court, Deputy Solicitor General Edwin Kneedler said the Biden administration believes the ACA is constitutional. The court is expected to issue a ruling shortly. If the court does determine the mandate is unconstitutional, Kneedler asked that it sever that section rather than find the entire law is unconstitutional.

Report calls for CMS to revamp its value-based payment approach

The Leonard Davis Institute of Health Economics at the University of Pennsylvania released a report this week that outlines the future of value-based payment. In an executive summary of the report, authors note that the federal government’s push from “volume to value” has only been partially realized, with few initiatives systematically reducing spending or improving quality. In addition to the mixed success of alternative payment models, factors such as the high costs of care, impending solvency of the Medicare Trust Fund, and health care disparities along racial and socioeconomic lines indicate the need for a revamped vision for value-based care.

The white paper outlines a new plan for CMS to follow over the decade. Those steps include the need to simplify the current value-based payment landscape and engage late-adopting providers, accelerate the movement for those already in the program from upside-only shared savings to a risk-bearing, population-based alternative payment models, and limiting the ability of providers to opt-out of value-based payment altogether and structure incentives to entice providers away from fee-for-service payment.

The authors write that the recommendations offer a path toward widespread adoption and success of alternative payment models, producing better health outcomes for all Americans, reducing wasteful inefficiencies and health disparities, and more effectively stewarding taxpayer funds to support other national priorities.

COVID-19 Update: One-third of US adults have delayed, skipped medical care

Thirty-six percent of nonelderly adults delayed or did not get care during the COVID-19 pandemic because they feared exposure to the coronavirus or because their health care provider limited services, according to a new Urban Institute report. The findings are based on the Urban Institute’s September 2020 Coronavirus Tracking Survey, a nationally representative survey of adults ages 18-64. The survey found that Black adults and adults with chronic health conditions were among those most likely to report delaying or not getting needed care. Rates of delayed or forgone care were particularly high among adults with mental health conditions. Nearly one-third of adults who delayed or went without care because of the pandemic reported doing so negatively affected their health, ability to work, or ability to perform other daily activities.

The findings underscore the importance of steps to address health issues that have not been attended to during the pandemic, the report noted, including assuaging fears about exposure to the coronavirus in health care settings, strengthening efforts to reduce coronavirus transmission and promote vaccination, and ensuring equitable access to telehealth services.