Under President Trump’s leadership—and following his vision for a reformed and renewed federal government—at HHS and across the Administration we are eagerly embarking on a new era of partnership and collaboration with America’s 50 states. And we believe that the basis for a successful federal-state relationship ought to be open and frequent dialogue.
Remarks As Prepared for Delivery
I. Greeting and Introduction
Good morning. It’s great to be back at a meeting of the National Governors Association—and not just because you’ve given me a good excuse to get out of Washington for a day.
I’m honored to be here because I recognize and appreciate the immense wealth of knowledge and experience represented in this room today. It is very encouraging.
Under President Trump’s leadership—and following his vision for a reformed and renewed federal government—at HHS and across the Administration we are eagerly embarking on a new era of partnership and collaboration with America’s 50 states. And we believe that the basis for a successful federal-state relationship ought to be open and frequent dialogue.
So, I’m pleased to be here, not only to talk to you about what’s going on at HHS, but more importantly to listen to—and to learn from—all of you.
And you couldn't have picked a more important topic for this morning's conversation—“The Future of Health Care” in America.
I say that not because of what’s going on in Congress right now, but because—if you think about it—every time we talk about healthcare we’re talking about its future. In fact, every policy debate—whether we’re talking about healthcare or anything else—is invariably a debate about the future.
What will our society, economy, and public institutions look like 5, 20, 100 years from now? What aspects of life will be unimaginably different in the future, and what will be familiar to us today? No one can know for certain and yet these questions lie at the heart of every policy discussion, which may help explain why our political debates can be so heated and rancorous sometimes.
As policymakers, our job is to come up with laws that are specific enough to accomplish our goals, but flexible enough to adapt to a future that none of us can fully imagine today.
This challenge is especially acute when it comes to healthcare policies, because healthcare and the practice of medicine are so inherently dynamic.
II. The Dynamism of Healthcare
Although the human body that Hippocrates studied and treated in Ancient Greece would look remarkably familiar to any doctor today, our understanding of the human body and the tools we use to heal its ailments are constantly evolving and advancing.
Doctors and medical professionals don’t resist these great advances in knowledge and innovations in technology—they embrace them, and often they help drive our biggest leaps forward.
This is the dynamism at the heart of medicine, and there is no healthcare system on earth that has done more to encourage and build our most effective life-saving innovations than the American healthcare system.
Today, we find ourselves on the cusp of radical new medical breakthroughs that have the potential to transform the practice of medicine as we know it.
From ultrasound probes that you plug into your smartphone and carry in your pocket to personal sensors that collect and analyze your vital signs and other health metrics 24/7, the medical technology of tomorrow will be more precise, user-friendly, personalized, and cost-effective than ever before.
Many of these technologies are so revolutionary that, ten years ago, most people would not have thought them possible. And yet here they are, confounding the best laid plans and challenging policymakers to write our laws and shape our public programs to be flexible and accommodating.
But there’s another important dimension to the dynamism of medicine and healthcare. Even though human physiology hasn’t changed much in the past few thousand years, the diseases that plague us are constantly evolving, often just a little faster than we can keep up.
Perhaps the best—and most tragic—recent example of this is the epidemic of drug addiction sweeping across our land.
III. Opioids
If someone had told the American people ten or twenty years ago that one of the first priorities of a new president would be setting up a panel on drug addiction and something called the opioid crisis, I think most would have been pretty confused.
And yet here we are, with opioids being a pressing issue for nearly everyone in this room.
While Congress took action over the past several years, through CARA [Comprehensive Addiction and Recovery Act] and the 21st Century Cures Act, states have really been leading the charge.
Take prescription-drug monitoring programs as one example. Forty-nine states have their own PDMPs. Many of them provide instant information to prescribers about a patient’s history with opioids and other risky prescription drugs. States have also not shied away from requiring providers to use these programs, if they find it necessary. They have also moved to share data across states, to make their systems that much more effective.
It is not an exaggeration to say that had the federal government stepped in and said, “We’re going to set up a system for the whole country,” we would not have the highly effective systems states have today.
States have led the dynamic response to a problem that most never dreamed would get this large or pressing.
Of course, there is an important federal role here, too. We have defined five strategies for fighting the opioid epidemic:
- Improving access to prevention, treatment, and recovery services, including the full range of medication-assisted treatment;
- Targeting availability and distribution of overdose-reversing drugs;
- Strengthening timely public health data and reporting;
- Supporting cutting-edge research on pain and addiction; and
- Advancing the practice of pain management.
In each of these efforts, there is a need for federal coordination, funding, or expertise.
But we can best accomplish goals like improving access to treatment—including medication-assisted treatment with naltrexone, buprenorphine, or methadone—by pursuing partnerships between the states and the federal government.
In a partnership, rather than a one-size-fits-all federal model, we can adjust to dynamic needs and challenges and tailor effective responses to a local context.
So, for instance, we disbursed $485 million in 21st Century Cures grant funds earlier this year to your states. Given that the same amount of money will be available for grants next year, the natural thing to do might have been to offer two-year grants.
But this fight is constantly changing, so we need to have a dynamic approach. And this is the first very large-scale grants program the federal government has done to fight the opioid crisis, so we have lessons to learn.
That is why we are gathering the best information we can this year to inform a new round of grants next year, which will emphasize the needs we see—with your input—next year and the best practices we see implemented from this round of grants.
We also have to empower states to direct existing state and federal resources toward combating the epidemic.
There is already some flexibility in the Medicaid program: A number of states, Rhode Island included, have State Plan Amendments that allow health home programs to meet the needs of people struggling with opioid addiction.
But Medicaid’s one-size-fits-all approach often hampers your ability to quickly address pressing problems in your state. Some states have considered specifically expanding Medicaid eligibility to fight addiction, but as you know, the Affordable Care Act provides the most generous funding not necessarily for especially vulnerable groups, and not for people struggling with addiction, but for any childless adults making up to 138 percent of the poverty line.
When the federal government puts a very heavy hand on the scale of how states use their own resources. We want to provide strong federal support for Medicaid, but do it in a way that recognizes states have dynamic needs. Administrator Verma is going to talk more about how we envision that happening: We want a more accelerated waiver process and more flexible funding.
And in some places, it is not just lack of funding that is keeping folks from treatment: It is lack of treatment beds and lack of providers willing to treat patients with addiction, period. During our national listening tour, we’ve heard from many people on long waiting lists for care—waiting lists that are sometimes a lot longer for those on Medicaid than on private insurance. That is a challenge that can only really be solved at a local level, though there will be support we can provide.
So the reason we’re eager to usher in a new era of state flexibility in healthcare is that state and local governments are the most responsive to the people they serve and the ever-changing challenges they face.
IV. Conclusion
The opioid crisis and our response to it thus far is a useful case study that ought to inform how we think about the future of healthcare in America, because we aren’t winning that battle—not yet.
States have responded aggressively, and Congress has belatedly taken action too. But we need to aim higher—we need to aim for more fruitful federal-state partnerships, more aggressive action on opioids, new approaches to everything from health insurance access to figuring out how to bring down the costs of medicines.
As some of you may or may not know, the NGA was founded to address a particular cross-border problem from the state level: the management of inland waterways.
You can think of the ever-changing nature of healthcare like a waterway: rivers never stay the same. Their banks, their currents, their level of flow are always shifting. Sometimes it’s imperceptible, but it ends up having huge effects.
This is how we ought to look at the future of healthcare, and how to get it right: There are constant shifts, some we can see, some we cannot. The only way to address that is to have the most collaborative relationship possible between the federal government, states, and our private-sector and civil-society partners, and to empower those closest to the challenges we face. We look forward to making that a reality under this Administration.
With that, I will hand it over to Administrator Verma.
CMS Administrator Seema Verma
Providence, Rhode Island
July 15, 2017
Thank you, Secretary Price. Thank you, Governor McAuliffe, for inviting us to participate in this conversation today. And thanks to all of you for being here.
Over the past few months, it’s been an honor to travel the country with Dr. Price and speak about the future of healthcare in America. And I always appreciate when he’s invited to speak before me, because he does such a great job setting the stage and really getting to the crux of the matter.
Today is no exception. The Secretary is absolutely right that our healthcare laws and programs need to be able to adapt to the dynamic nature of medicine. And he’s absolutely right that this means we need to empower states with the flexibility and authority they need to create the kinds of policies that meet the unique health needs of their citizens.
Before I became CMS Administrator, I spent my days helping governors—including some of you—find ways to provide affordable coverage to citizens in need, which involved working and negotiating with CMS.
Unfortunately, I often found CMS to be more of an adversary—a barrier—when it should have been a collaborative partner in developing solutions to improve access to high-quality, affordable care. I know many of you have had similar experiences.
So now that I have the privilege of serving as CMS Administrator, my goal is to focus the Agency on offering you more flexibility, so that America’s governors come to see CMS as an ally rather than an adversary.
That’s why one of the first things we did earlier this year was send a letter to the governors of all 50 states encouraging them to use State Innovation Waivers under Section 1332 of the ACA to develop new, innovative policies tailor made to meet the unique healthcare needs of their citizens. Then, in May, we released a checklist that helps simplify the process for states that are interested in applying for a State Innovation Waiver.
So far, we’ve been very encouraged by the response. It is clear that many governors are eager to break free from some of the most restrictive federal healthcare regulations and come up with their own solutions that they know will help improve health outcomes for their citizens.
For instance, we recently approved a 1332 waiver for the state of Alaska under the leadership of Governor Bill Walker. This waiver is a great example of how state-driven policy innovation can help improve the health and well-being of the American people. Thanks to Governor Walker’s leadership, we are able to temporarily stabilize the market so that more Alaskans will be able to access to the kind of affordable, high-quality care they deserve.
With the reinsurance program this waiver supports, Alaskans will see lower premiums, potentially as much as 20 percent less than they would have otherwise.
And they will achieve all of this and more in a cost-effective, sustainable way that doesn’t increase the federal deficit.
In addition, at CMS we are starting a major deregulation initiative that will make it easier for healthcare providers and states to spend more time and resources focusing on delivering high-quality care, and less time and resources trying to comply with complex regulations that don’t meaningfully improve care, quality, or safety.
We have also been working with members of the Senate to outline new options for states to reimagine coverage in ways that allow Medicaid to work in tandem with tax credits available under BCRA, so that low-income Americans have access to high-quality, affordable coverage.
Unfortunately, the data I understand was presented to this group does not consider the full-range of funding opportunities available under BCRA, including tax credits, the stability fund, and opioid funding, as well as federal dollars available through the Medicaid. I take significant issue with this information.
BCRA also gives states unique opportunities for states to design systems that ensure their citizens have access to affordable, high-quality coverage. As everyone in this room well knows, there isn’t a one-size-fits-all solution to every problem. Working with governors and state officials to create programs that address the unique needs of their citizens in a sustainable way has long been a passion of mine, and as CMS Administrator I look forward to continuing that work with all of you well into the future.
As Dr. Price mentioned, the basis of any fruitful federal-state partnership must be open and honest dialogue, so with that let’s start the conversation. I look forward to answering your questions and hearing your ideas about how we can make healthcare better for your citizens. Thank you.
