By Jeff Overley

Law360 (April 15, 2021, 11:15 PM EDT) -- Chiquita Brooks-LaSure, the Manatt Phelps & Phillips LLP veteran nominated to run America's largest health care programs, sketched her vision Thursday on Capitol Hill for telemedicine, clinical trials and other topics that have become increasingly intertwined with issues of race and class during the coronavirus pandemic.

Brooks-LaSure, a managing director at Manatt's legal and consulting group, Manatt Health, fielded questions for nearly three hours during a Senate Finance Committee hearing on President Joe Biden's nomination of her to serve as administrator of the Centers for Medicare & Medicaid Services.

If confirmed, Brooks-LaSure would become the first Black woman in charge of CMS, which has a panoramic policymaking portfolio and oversight of more than $1 trillion in annual government spending. She used her opening remarks Thursday to spotlight the disproportionate impact of COVID-19 on "communities of color."

"My own hometown, a predominantly Black community where my parents still live, experienced higher rates of COVID infections and deaths compared to many of our surrounding communities," Brooks-LaSure said.

The nominee also called attention to other populations that often face distinct health challenges, telling senators that COVID-19 placed "those with disabilities at great risk," and that she has worked to "expand coverage options, especially for those living in rural parts of the country."

Before joining Manatt in 2016, Brooks-LaSure helped to develop the Affordable Care Act as a staffer on the House Ways and Means Committee, and she helped to implement the law as a deputy director at CMS. The ACA delivered financial help to many lower-income Americans by subsidizing private health insurance, and in her previous stint at CMS, Brooks-LaSure was a point person on efforts to convince disproportionately rural states to accept the ACA's Medicaid expansion.

Race, poverty and geography are closely connected to so-called social determinants of health, which have gained prominence during the pandemic. Senators on Thursday invoked those disparities repeatedly when pressing Brooks-LaSure for her views on their health policy priorities.

As one example, Sen. Robert Menendez, D-N.J., noted that drug and device makers swiftly created effective vaccines and tests for COVID-19. But he added that "members of the most heavily impacted communities do not have equal access to clinical trials for these innovations."

"I believe we have to take active steps to remove these barriers," Menendez told Brooks-LaSure. "What role do you see for CMS to play in improving minority clinical trial participation?"

She responded by calling clinical trial diversity "a crucial issue" and suggesting that CMS can do more to "work with trusted partners."

"One of the things that I think we've learned with the pandemic is how important it is to have the medical community [and] community organizations really making sure that communities of color field trust in these types of programs," Brooks-LaSure said.

Several senators also quizzed Brooks-LaSure about CMS' temporary expansion during the pandemic of telemedicine — health care delivered via video or phone — and how Congress should act to allow permanent expansions of telehealth coverage.

"Patients and providers have benefited from expanded access to telehealth," and lawmakers should "implement appropriate reforms based on the lessons we've learned," Idaho Sen. Mike Crapo, the committee's top Republican, said Thursday.

Brooks-LaSure agreed, telling committee members that her brother is a psychologist who has "been able to see more patients during a difficult time" because of telehealth, and that she will "work with all of you" on new congressional authority for wider telehealth coverage.

Telemedicine can be especially useful to rural and lower-income Americans who lack easy access to health care providers. At the same time, it can also be especially hard for those Americans to use since rural areas sometimes lack broadband internet service and low-income individuals may not own a smartphone or computer.

Sen. Maria Cantwell, D-Wash., urged Brooks-LaSure on Thursday to opine on whether telehealth services should receive the same reimbursement as in-person services. Brooks-LaSure avoided giving a direct reply, prompting a gentle tsk-tsk from Cantwell.

"I consider that a little bit of a punt," Cantwell said, advocating largely equivalent reimbursement.

Brooks-LaSure appeared Thursday alongside Andrea Palm, who has been a top official at the Wisconsin Department of Health Services and whom Biden nominated to serve as deputy secretary of CMS' parent agency, the U.S. Department of Health and Human Services.

Palm drew fewer questions than her fellow nominee, but she did encounter detailed inquiries about the 340B program, which guarantees drug discounts to clinics and hospitals in lower-income areas and also generated discussion at the confirmation hearing of newly confirmed HHS Secretary Xavier Becerra.

Sen. John Thune, R-S.D., complained that he has "heard concerns recently" about drug manufacturers "not reimbursing contract pharmacies," and he asked Palm how she would ensure that clinics and hospitals "are not harmed by these actions."

Palm responded by vowing to ensure that HHS is "implementing legislative intent" and helping to get "safety net providers in low-income communities the access that they need" to affordable drugs.

Although earnest policy dialogues dominated Thursday's hearing, there were lighter moments, including when Sen. Tom Carper, D-Del., sought to clarify how he should address the CMS nominee.

"Ms. LaSure — do people call you Ms. LaSure?" Carper asked. "Or do they call you Ms. Brooks-LaSure?"

The Manatt Health adviser smiled and replied, "They call me Chiquita."

--Editing by Jay Jackson Jr.

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