Trump’s Pick for CMS Chief Comes With Medicaid Experience

Seema Verma’s consulting firm helped shape Medicaid expansion in Indiana

President-elect Donald Trump has tapped Seema Verma, a health care consultant, to head the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, Medicaid, and the Children’s Health Insurance Program and has a budget of approximately $1 trillion in 2016. According to a report from Kaiser Health News, Verma comes to the job with extensive Medicaid experience. Her consulting firm, SVC, Inc., worked closely with Indiana Governor Mike Pence to design that state’s Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA).

The expansion, known as the Healthy Indiana Plan or HIP 2.0, went into effect early last year, and Verma’s involvement may be important as Congress and the Trump administration, including Vice President-elect Pence, make decisions on the future of the PPACA.

Indiana’s Medicaid expansion was designed to appeal to conservatives, according to the Kaiser article. HIP 2.0 asks covered people to make a small monthly payment to access health insurance. A missed payment can result in a six-month lockout from insurance coverage. Those provisions aren’t allowed under traditional Medicaid, but Indiana obtained special permission from CMS to implement them through a waiver.

Other Republican-led states, such as Iowa, Ohio, and Kentucky, have contracted with Verma’s firm to help them submit to the federal government their own Medicaid expansion proposals that also include conservative provisions, such as asking recipients to pay for some of their care, or requiring them to work or be actively looking for work.

Nearly 410,000 people are members of HIP 2.0, according to the latest data from the state.

But HIP 2.0 has its critics. David Machledt, a policy analyst with the National Health Law Program, which advocates for health care for low-income individuals, argued that the cost-sharing provisions and temporarily removing people from Medicaid will reduce participation in the program. Nevertheless, Machledt said that if Medicaid expansion continues, Verma’s pick to head the CMS could mean that proposals similar to Indiana’s may be more likely to be approved.

Joan Alker of the Georgetown Center for Children and Families agrees. “It is a good thing that she has experience with Medicaid, and it is a positive that Governor Pence worked with Ms. Verma to advance a version of Medicaid expansion,” she said. “But I think if you look at the totality of the Trump administration’s picks today—Congressman Price as well as Ms. Verma—this represents potentially a very damaging and chaotic restructuring of the Medicaid program.” Price has advocated severely cutting Medicaid funding.

“The Healthy Indiana Plan has occurred in the context of generous federal funding,” she said. “And I think some of that is on deck to go away.”

But Verma may be a smart pick, said Indiana Representative Charlie Brown, the ranking Democrat in the state’s public health committee. “She is a smooth operator, and very, very persuasive,” he said. Brown worked in opposition to Verma in crafting the Healthy Indiana Plan, but he said she worked effectively across party lines to incorporate the Pence administration’s wishes into the program.

“She’s very resourceful and intelligent,” said Brown. “But the question now becomes, ‘What will be her marching orders as they relate to Medicare and Medicaid?’”

Verma’s role in shaping Indiana’s health care policy was not without controversy. According to a 2014 article in the Indianapolis Star, she has received millions of dollars from the state through her work with the Indiana government. She was also paid by Hewlett–Packard, a Medicaid vendor that received more than $500 million in state contracts. Government ethics experts told the Star that the arrangement presented a conflict of interest.

Source: Kaiser Health News; November 29, 2016.