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Medicaid is not a “workfare” program. It’s our nation’s primary method of covering health care for low-income Americans.

Seema Verma, President Donald Trump’s nominee for Administrator of the Centers for Medicare and Medicaid Services, wants to change that. Although her nomination hasn’t garnered much press to date, it deserves more attention. Verma’s lack of experience with Medicare and with running a large agency are bad enough. But the harmful effect her policies could have on state Medicaid programs and their beneficiaries, in conjunction with likely congressional actions, is even worse.


Except with respect to the most fragile and vulnerable beneficiaries, Verma regards Medicaid not as a health care program but as a temporary pathway “for people to lift themselves out of poverty toward a state of self-sufficiency.” Toward that end, she believes states should have greater leeway in designing their Medicaid programs as they see fit. Most notably, she supports state efforts to treat Medicaid as a training program to make low-income, “able-bodied” Medicaid beneficiaries into responsible, gainfully employed, privately insured members of society. She points to the Healthy Indiana Program, on which she worked under then-Governor Mike Pence, as a model for other states.

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