Given her extensive experience reforming state Medicaid agencies, Seema Verma, the next CMS administrator, could lead a nationwide effort to make the poor on Medicaid pick up some of the costs of their insurance coverage.
As founder of SVC, a national health policy consulting company, Verma helped craft Medicaid expansion plans in Indiana, Iowa, Kentucky, Michigan and Ohio. Her Indiana plan, completed for Gov. Mike Pence, was the first in the nation to make Medicaid recipients pay small sums when they signed up for coverage.
Patient advocacy and policy experts agree that Verma's philosophy, which is dubbed “personal responsibility,” 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 unemployed 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.
Many advocates for the poor worry such an approach will reduce enrollment in the program. “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 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 waiver requests. 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.
Yet her history in pursuing waivers reveals an ability to cross 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.”
Verma is declining interviews prior to her confirmation hearing.