For The Record

Medicaid agency nominee slowed by waiver disputes similar to Georgia’s

By: - April 23, 2021 4:30 am

Georgia Gov. Brian Kemp plans to forge ahead with a limited version of Medicaid expansion that is now held up by the Biden administration. This is despite huge financial incentives to fully expand health care access in the recent federal $1.9 trillion COVID relief package. the_burtons/Getty Images

WASHINGTON — Wisconsin’s Andrea Palm moved a step closer Thursday to becoming deputy secretary of the U.S. Department of Health and Human Services, after the Senate Finance Committee advanced her nomination to the full chamber.

The panel approved Palm’s nomination on a 20-8 vote, with all Democrats and six Republicans in support.

But the Finance Committee deadlocked on the nomination of Chiquita Brooks-LaSure to lead the Centers for Medicare and Medicaid Services, due to Republican opposition to a recent decision by the Biden administration to revoke support for changes to Texas’ Medicaid program.

That Medicaid waiver had been approved by the Trump administration, and revoking the 10-year extension jeopardizes $11 billion in annual federal funding for Texas.

Federal health officials said in a letter to Texas officials that the decision was made because the approval didn’t go through the full administrative process. But Sen. John Cornyn, (R-Texas), citing a Washington Post report, said the decision was part of a broader effort to push Texas and 11 other states to expand Medicaid and cover more low-income residents as allowed under the 2010 Affordable Care Act.

Georgia is one of those states and earlier this month its two U.S. Senators and Democrats in its congressional delegation urged the Biden administration to “fully rescind” a health care plan federal officials paused in February.

The Georgia plan promoted by Gov. Brian Kemp would slightly expand Medicaid to as many as 50,000 people if they complete 80 hours every month of work, community service or job training or if they are full-time higher education students. The federal agency objected to these strict eligibility requirements in a letter.

A top Trump administration official traveled to Atlanta in October to mark the federal approval of a plan intended to help put insurance cards in the hands of residents who make too much to qualify for Medicaid but too little to qualify for subsidies on the federal exchange.

Georgia lawmakers included $76 million in next year’s budget just to start building Georgia’s program this July. And without the restrictive eligibility requirements, Georgia’s plan would become much more expensive – potentially as much as $650 million, according to the Georgia Budget and Policy Institute.

Cornyn said he had been planning to vote for Brooks-LaSure before the Medicaid waiver was rescinded, but could not support her until it is resolved.

“It’s pretty bold to admit this is not about an administrative error at all — it’s about jamming the state into a decision that the elected officials there have chosen not to make,” Cornyn said, describing it as “a high-stakes game of chicken” that “erodes the partnership between the state and CMS.”

Sen. Ron Wyden, (D-Ore.), told Cornyn that while the committee was still seeking to advance Brooks-LaSure’s nomination, he pledged to work with Cornyn on the matter and said the Biden administration is taking the issue seriously.

Palm’s nomination now awaits a floor vote in the Senate. The nomination of Brooks-LaSure will require a discharge vote by the full Senate before it can advance.

Palm most recently served as Wisconsin’s Department of Health Services secretary-designee, where Republican state lawmakers refused to confirm her and challenged her efforts to respond to the coronavirus pandemic, the Wisconsin Examiner has reported.

The GOP-controlled state Senate accused her and Democratic Gov. Tony Evers of overreaching through public health declarations and mask mandates. Republican lawmakers also took Palm to court to overturn those public health orders.

Prior to her work in Wisconsin, Palm held a number of roles at HHS during the Obama administration, including as acting assistant secretary for legislation, chief of staff and senior counselor to the secretary. She worked on the Affordable Care Act and was involved in the agency’s fight against the opioid crisis.

She spent her 20s as a caseworker, finding safe homes for children and working with people in behavioral health crises. During her Senate hearing, Palm said that work drew her to public service and “made me want to change the system.”

Born and raised in rural upstate New York, Palm has a bachelor’s degree from Cornell University and a master’s degree from Washington University in St. Louis.

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Laura Olson
Laura Olson

Laura covers the nation's capital as a senior reporter for States Newsroom, a network of nonprofit outlets that includes Georgia Recorder. Her areas of coverage include politics and policy, lobbying, elections, and campaign finance.