Given her extensive experience reforming state Medicaid agencies, the next CMS administrator could lead efforts to make Medicaid patients more financially responsible for their insurance coverage.
President-elect Donald Trump Tuesday announced that Seema Verma, the president, CEO and founder of SVC, a national health policy consulting company that has helped craft Medicaid expansion plans in Indiana, Iowa, Kentucky, Michigan and Ohio, would work under Rep. Tom Price, who currently is a congressman from Georgia but has been nominated for HHS secretary.
Patient advocacy and policy experts agree that Verma's philosophy encourages people to take charge of their healthcare. Verma has supported charging premiums to individuals above and below the poverty line and freezing beneficiaries out of coverage if they don't pay. She is also in favor of mandating enrollees search for work while being covered and that they are timely when reapplying for Medicaid coverage or else face a lockout period that could last a year.
“The vision of Medicaid under Verma is troubling,” said Joan Alker, executive director of the Georgetown Center for Children and Families. “It's a vision where there will be many new barriers to coverage.”
Even small contributions can cause some low-income people to choose to bypass coverage, according to Judy Solomon, a vice president for health policy at the left-leaning Center on Budget and Policy Priorities.
For example, a recent state evaluation of Indiana's HIP 2.0 waiver, which Verma helped develop, found that about one-third of those eligible don't enroll because they can't or don't want to pay a premium, Solomon said.
The Obama administration has largely denied more conservative suggestions made by Verma in crafting waivers. They include such things as a requirement to be actively looking for work as a condition of coverage or kicking those under the federal poverty level off coverage for not paying premiums.
It's likely those proposals will be approved should states ask for them in the future, according to Sara Rosenbaum, a healthcare policy expert at George Washington University.
But patient advocacy groups say Verma could also push back on Trump's promise to repeal and replace the Affordable Care Act.
The belief is that Verma would likely call for an adequate replacement to mitigate significant coverage loss for an estimated 12 million people who gained coverage through Medicaid expansion provisions in the ACA.
Her history with 1115 waivers show she crosses party lines to ensure coverage, said Trish Riley, executive director of the National Academy for State Health Policy. “She helped forge a middle ground that enabled some more conservative states to cover more people—childless adults—through Medicaid expansion via private options.”
In the event Trump is able to follow through with plans to turn Medicaid into a block grant program with a per-beneficiary cap, states will have an ally in Verma.
Richard Murdock, executive director of the Michigan Association of Health Plans, says Verma thinks creatively and emphasizes flexibility in allowing states to take the lead in crafting programs that best suit their residents.
Price shares a similar philosophy of allowing states to manage their Medicaid dollars. Nominations for both Price and Verma must be confirmed by a Senate vote.
Verma is also likely to focus on overhauling CMS' efforts to coordinate care for people dually eligible for Medicaid and Medicare. Demonstrations aimed at better serving an often chronically ill population have lacked participation. Verma has said health plans should have more tools at their disposal to boost participation, according to Jeff Myers, CEO of Medicaid Health Plans of America.
Reached via email Tuesday, Verma declined an interview.