Seema Verma doesn’t shrink from a fight, and she’s had plenty of them since she became CMS administrator in March 2017.
The former Medicaid consultant has championed many policy initiatives that have polarized the healthcare world.
While her agenda and personal style elicit controversy, veteran CMS watchers give Verma credit for boldly articulating and pursuing her vision of strengthening market forces to improve healthcare quality and access, and reduce costs. That includes goosing the sluggish transition to value-based payment.
“A lot of people underestimated her,” said Dr. Avik Roy, president of the Foundation for Research on Equal Opportunity, a free-market think tank. “She has turned out to have a pretty thick skin and strong will to be effective,” adding that the CMS under Verma “has been much more important than in the past in terms of being an engine of policy change.”
“If you are trying to make real, lasting, consequential changes to the healthcare system—changes that will actually help patients—you’ll never make everyone happy,” Verma said in an emailed response to questions.
It’s unclear how many of her initiatives will ultimately survive court battles, however. She’s also become embroiled in controversies surrounding the agency’s use of public relations firms and has a reportedly strained relationship with HHS Secretary Alex Azar, which, according to an article in Politico, disrupted Trump administration healthcare initiatives.
Nevertheless, her efforts have placed her in the top spot on Modern Healthcare’s ranking of the 100 Most Influential People in Healthcare, the first CMS administrator to hold the position.
Bernard Tyson, Kaiser Permanente’s late CEO, was selected for the second slot on the Most Influential list. Tyson, who died of a heart attack last month after heading the giant hospital and insurance system for seven years, was named to the list for pioneering the movement of health systems to address the social determinants of health.
Appearing together at the TIME 100 Health Summit in October, Verma and Tyson agreed that the industry needs to move more rapidly toward a value-based design. Tyson, though, countered Verma’s frequent attacks on the Affordable Care Act, arguing instead that policymakers should fix what’s broken in the law rather than “blow up” the current system.
Verma and the CMS have charged ahead on Medicaid work requirements, expansion of short-term health plans lacking consumer protections, Medicaid block grants, and narrower nondiscrimination protections for people based on sex and race. The agency also pursued rules around offering price transparency, reducing 340B drug payments, and establishing site-neutral Medicare payments.
Many of those initiatives have been blocked wholly or partly by the courts, or face pending legal challenges.
“You don’t have to like it, but her work on giving states more flexibility to require community engagement and work is the most ambitious attempt I’ve seen to let states change the way they handle their Medicaid programs,” said Joseph Antos, a healthcare scholar at the American Enterprise Institute.
Verma also has drawn attention for her frequent speeches bluntly criticizing: the Affordable Care Act; providers and drugmakers that charge too much; Medicare for all proposals; cumbersome regulations; and wasteful spending.
“If we don’t forcefully explain what makes (Medicare for all) proposals fatally flawed today … they may wreck our healthcare system tomorrow,” she said.
“In terms of pursuing the Trump administration’s priorities, she has undoubtedly been influential and reasonably bold, and I give her credit for that,” said Billy Wynne, a Democratic health policy consultant. He praises her agency’s proposals for reducing drug prices while criticizing her Medicaid moves as endangering coverage.
Meanwhile, HHS’ Office of Inspector General announced in June that it’s investigating whether the CMS’ millions of dollars in contracts to hire Republican media and political consultants to serve as Verma’s communications aides complied with federal law and HHS policies. That office said its findings are due in early 2020.
Her office more recently has come under fire for its expensive campaign to boost Verma’s visibility through interviews, speeches and appearances in prestigious forums.
In addition, Politico reported that feuding and personal rivalry between Verma and Azar has disrupted Trump administration healthcare initiatives, including release of an ACA replacement plan.