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Medicaid could be in for a major overhaul.

President-elect Donald Trump’s pick to lead the federal Centers for Medicare and Medicaid Services is the architect of Republican-led efforts to cut the program’s costs at the state level and require some beneficiaries to get jobs and pay for a portion of their own care.

Seema Verma, president of a national health care consulting company, is best known for her work in Indiana with Vice President-elect Mike Pence, whose gubernatorial administration reshaped Medicaid by requiring recipients to pay premiums and tracking their compliance with healthy behaviors.


Her selection to lead CMS is likely to provoke strong reactions from Democrats and advocates of universal coverage and the Affordable Care Act who argue that her reforms have restricted access to medical services. Trump also selected Republican Congressman Tom Price of Georgia, a fierce critic of Obamacare, to be secretary of Health and Human Services.

He called Price and Verma a “dream team” to help him repeal and replace Obamacare and reform other health policies after he takes office in January.


The selection of Verma is likely to embolden state proposals to cut Medicaid costs and institute changes that require low-income people put more “skin in the game,” as many Republicans have said, regarding their health care and medical expenses. It could also bolster Republican-led efforts to pare Medicare spending and shake up coverage options for millions of Americans.

Verma has worked in the trenches of health care policy for more than 20 years. She helped launch Indiana’s Medicaid reform package in 2007 and became especially influential following the 2010 passage of the Affordable Care Act, which allowed states to significantly expand their Medcaid programs to cover more low-income residents.

Many states led by Republican governors took advantage of the expansion — and its influx of federal aid — but wanted to institute reforms to help control the program’s costs and encourage people to engage in healthier behaviors and get off government assistance.

The Healthy Indiana Program created savings accounts for recipients, which works in a similar fashion to commercial insurance plans, by requiring them to make premium-like payments and more carefully budget their use of health services.

A blog post Verma co-wrote said the program “respects the dignity of each member by setting a fair expectation of personal investment and engagement in his or her own well-being. Contributions are a way for members to demonstrate personal responsibility, but they also encourage members to stay engaged with their health plan.”

Health care providers in Indiana supported the reform proposal because it included raises from Medicaid — an average of 20 percent for hospitals and 25 percent for doctors. The state’s hospital association released a statement this morning applauding Verma’s “truly transformational vision for health care.”

“She also deeply understands the critical importance of coverage to those served by programs like Medicare and Medicaid, and is a superb choice” to lead CMS, the statement said.

Her proposals, while criticized by some Democrats, have also drawn ire from some Republicans who argue they do not go far enough to cut spending. With the Affordable Care Act still picking up the tab for Medicaid expansion, the exact financial impact of Healthy Indiana on the state’s coffers remains unclear.

As president of SVC, Inc., the consulting company she founded, Verma also helped to craft Medicaid waiver proposals in Iowa, Ohio, Michigan, and Tennessee.

She has also worked on a highly controversial reform package in Kentucky, where the state’s governor wants to require people with incomes below the federal poverty level to pay premiums. The proposal would also require beneficiaries who aren’t primary caregivers to work or get job training. Both the premiums and work requirements have been opposed by the Obama administration.

But Verma’s selection to head CMS will quickly change Washington’s posture toward Kentucky’s proposal and many others that seek to rein in spending. It could also have much broader implications for federal efforts to accelerate performance-pay for doctors, a plan implemented under Obama that aims to tie doctor compensation to the quality of patient outcomes.

Those changes, instituted through the law known as MACRA, have achieved bipartisan support in Congress, and could be accelerated under the Trump administration. Verma’s stewardship of CMS will also affect how hospitals are rated and reimbursed for their care, as well as the kinds of penalties they might face for falling short of federal quality benchmarks.


  • As if people on Medicaid do not already have far more “skin in the game” than the hospitals, insurance companies, doctors (yes, doctors) and politicians who make the policies – and the profits. I’ve worked with low income Americans for two decades and have never ever seen someone make a frivolous visit to the doctor or hospital. To the contrary, people are far more likely to wait longer than is medically optimal because they can’t afford transportation, can’t take off from work, can’t get an appointment with a primary care provider, or can’t face the bureaucracy involved in getting getting the care that they need.

  • It is important to note that Medicaid also pays for all of the services people with disabilities receive-autism supports, residential services, medical services, employment support services, specialized foster care. Georgia has almost 9000 people on the waiting list for developmental disability Medicaid services and at the rate the funds are released, it will take 87 years to get off the waiting list. Medicaid cuts or block grants will mean those numbers will double and people with developmental disabilities may not be able to get any services after high school.

  • Can she single-handedly and unilaterally require all drug companies to align drug prices for Medicaid to be the same as VA’s with federal legislation or would this require legislation by each State? California residents voted down Proposition 61 which may no longer be necessary!

  • Why don’t they just be done with it. Build Euthanasia Centers and send us off in a comfortable, humane way … like in Soylent Green. A few more appointments like this one and the HHS one and I’ll be ready to kiss this place goodbye!

  • Costcutting of federal funds for state Medicare & Medicaid services fits as a policy rejig for what Trump stands for. The eventual loss of coverage will only accelerate health bankruptcy amongst vulnerable sections. Herein, there’s a stark absence of the doctor’s and hospital’s role in articulating bold policy initiatives and the void is being filled up with health touts and contractors.The situation is no different in India, another vibrant democracy.This calls for urgent filling up of leadership gap amongst doctors and healthcare providers. Thanks.

  • I’m so afraid for not just myself who’s on Medicaid due to my being disabled on SSI, and yes if one is on SSI, Medicaid is what you get and if I didn’t have Medicaid I don’t think I would be alive today. Given that, it’s beyond shocking to me that want to make people pay premiums for medicaid, and it doesn’t matter if you’re under the poverty level like myself, and that I’ve got chronic disease, the healthier living thing makes no sense as to how would healthy living which I implemented into my life year’s ago , way before I ever got sick makes no sense. I’m afraid for many people who are sick and on Medicaid including many senior citizens including my own mother. I know that she won’t be able to pay her Medicare premiums without her Medicaid, which now they’re saying that the Medicare premiums are going to go way up and she definitely won’t be able to pay for any of her Medicare because they’re going to slash Medicaid, and Medicaid pays for her medications alongside her Medicare now , but with these proposals she’s going to lose her Medicaid, and she’s not going to be able to survive. what is going on here is truly beyond disturbing to say the least. The notion that they’re going to literally kick many people off of Medicaid is simply

    • yeap and that is bs. I ama 55 yr od female and have medication I have to take every day of my life or die and if i lose my coverage it doesnt sound like anyone gives a s—-. must be nice to be rich… ( these are truly the end times)

    • yeap and that is bs. I ama 55 yr old female and have medication I have to take every day of my life or die and if i lose my coverage it doesnt sound like anyone gives a s—-. must be nice to be rich… ( these are truly the end times)

  • We the people should live for ourselves and live healthy. We cannot live by abusing the system. Mutually subsidized system encourages bad behaviors and lifestyle. It is time to minimize such behavior by being responsible.

    • I honestly am not sure if I even want to have to survive through another month of hand to mouth poverty along with my body simply…failing to thrive. Cystic Fibrosis is killing me, and it is not a good way to go…
      I could handle that. Easily! But dying in poverty is killing my soul. I want to work! Please, find me a job that wouldn’t mind watching me die, terribly, while the rest are busy trying to ignore the depressing spectacle…but what would be the damn point? I cannot work full time or even part time…unless part time allows for hemoptysis at work and IV antibiotic therapy too. And doesn’t mind my pneumonia coughing at lunch.
      A moot point anyway considering that my $733 a month “living wage” would immediately cease if my resources ever go over $2,000. That’s not just money in the bank. That’s my car, my housing, my…everything. Never will I be able to live comfortably and without the worry that I’ll not be able to afford to eat this month…let alone buy my loved ones Christmas presents! I am 32 years old, I have 30% lung capacity left and no hope for a lung transplant on Medicaid. I am also smart, witty, and well read. I am also scared to death to die on Medicaid. I already do my best to not react to the stigmatized treatment by doctors who can only look at me as another expendable and likely ungrateful Medicaid patient…because if those same doctors looked at me as a real live human being…they could not treat me they way they do…the way they Must without being destroyed inside. I understand that, I understand them. But God, sometimes…I just want to be able to eat all month long and not have to feel guilty about it. I want to be able to go for a drive in my car… for pleasure, not because I’m on my way to or from another pointless doctor’s appointment that never fixes anything but does cost more than I have to spare for gas and parking both ways. I want to contribute to society. Desperately. But my contributions are not allowed unless my resources stay under $2,000.

    • So someone born with cerebral palsy, Downs Syndrome, autism, cognitive delays are that way because they weren’t responsible in their healthcare? People who have dementia just weren’t responsible with their health?Your comment shows your ignorance and selfishness. Everyone’s health fails them eventually, when yours fails you, you should remember your lack of compassion for others. I suspect you will pull an Ayn Rand and want to be supported like everyone else.

  • I like the idea of strong incentives for “healthy” living while on Medicaid. 75% of all medical costs are due to chronic diseases, of which 75% are preventable through living a healthy lifestyle. Businesses have already realized this and tie benefits to wellness challenges, tracking your weight, etc. Maybe it’s time for Medicaid to do something similar.

    Sadly, tying benefits to everyday choices may be the only way to significantly reduce healthcare costs.

    • I’m not sure where you are getting your numbers, but those just don’t seem right. 86% of healthcare spending is on someone with one or more chronic medical conditions, but I’m not sure there’s a single statistic for how much of chronic disease (which includes cancer too) is avoidable through healthy living. As an aside, those wellness programs in businesses have very little evidence of efficacy in getting people healthier or reducing health costs. Not to say we shouldn’t try!

      I like the idea of incentives, but blanket requirements do not account for the complexities of the system. Most on medicaid don’t want to be on it; it’s hard to use and half the country makes it damn hard to make you feel okay about having it. Are we going to take the time to teach financial responsibility to every disabled person on Medicaid? Are we allocating additional resources to that? Also, forcing a work requirement is not a good idea considering it would continue to encourage low wages. We’d effectively be paying for McDonald’s and Walmart employer healthcare, all without contribution from the corporations. If they are going to benefit, they should contribute in some manner.

    • Conditions like Lupus, Type 1 Diabetes, Rheumatoid arthritis, cystic fibrosis, Multiple Sclerosis are all chronic and none are related to behaviors. How about treating behaviors like addiction as a medical issue, so people don’t have chronic health problems? That is a novel and cost effective idea.

    • Oh that’s just peachy……I haven’t had an increase in my Medicare but 1 time in 7+ years but my out of pocket expense has risen every year…..come on TRUMP I’m counting on you…..

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