The Next Trump Health Official With A Looming Confirmation Fight

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With former Rep. Tom Price confirmed as the new secretary for Health and Human Services (HHS), now the confirmation fight will turn to the brains behind Indiana’s hotly debated version of Medicaid: Seema Verma.

President Trump nominated Seema Verma, founder and CEO of health policy consulting firm SVC, Inc., to head the Centers for Medicare and Medicaid Services in November.

“She has decades of experience advising on Medicare and Medicaid policy and helping states navigate our complicated systems,” Trump said in a statement last year. “Together, Chairman Price and Seema Verma are the dream team that will transform our healthcare system for the benefit of all Americans.”

Verma’s nomination has taken a backseat while the Senate battled over Price, but after he was confirmed at 2 a.m. Eastern Friday morning, Verma is likely the next health care nominee on the docket. The Office of Government Ethics is close to publicly posting an agreement with Verma — a routine procedure for vetting candidates for a federal post which will address any potential conflicts of interest, HHS told CQ Roll Call this week.

The Centers for Medicare and Medicaid Services (CMS) is the largest agency under HHS auspices and one of the most far-reaching agencies in the federal government. As the administrator of Medicare, Medicaid, and — for as long as it’s around — Obamacare, the agency’s programs cover almost one-in-three Americans.

The administrator’s position gained some notoriety under the Obama administration as the person in charge of implementing Obamacare. Former CMS chiefs Marilyn Tavenner — who now heads up an organization called America’s Health Insurance Plans — and Andy Slavitt, were both tasked with facing the GOP-led Congress in its oversight investigations of Obamacare.

Verma’s expertise, however, is with Medicaid and the ACA’s role in expanding it.

As the CEO of health insurance consulting firm SVC, Inc., Verma worked with Vice President Mike Pence, then Indiana governor, to design Indiana’s version of a Medicaid, eligible for 90 percent funding by the federal government as part of Obamacare. Verma helped to author both the original Healthy Indiana Plan with former Indiana Gov. Mitch Daniels, and to update the program into HIP 2.0 to meet the Affordable Care Act’s requirements.

Republicans have largely opposed expanding Medicaid to those above the poverty line; as part of the ACA, Medicaid eligibility was broadened to 138 percent of the federal poverty level. Verma’s Indiana plan captured conservative ideals that won plaudits from some on the right but will likely raise questions from Democrats during Verma’s confirmation process.

Under the plan, participants pay no more than 2 percent of their income toward a monthly “premium.” The payments go into a health savings account, which customers keep control of, and can use to pay monthly premiums for insurance coverage. Verma noted in an August, 2016, Health Affairs article that participants continue to own these contributions and can be refunded unused portions if they choose to withdraw from the program.

Democrats have taken issue with the program, because if participants don’t pay their premiums within a 60-day grace period, they can lose their coverage; those above the poverty line are required to wait six months to sign up for the program again. Opponents of the requirements have said the system is confusing to customers and argue that requiring premiums reduces the number of participants — issues likely to be touched on during Verma’s confirmation hearings.

“Contributions are a way for members to demonstrate personal responsibility, but they also encourage members to stay engaged with their health plan, providers, and overall personal health,” Verma wrote in Health Affairs, along with co-author Brian Neale, a health policy adviser to Pence.

“Because HIP Plus members’ own dollars are at stake, they have ‘skin in the game’ and therefore an incentive to make cost-conscious health care decisions,” they continued.

HIP 2.0 has been successful in Indiana, according to a report by the consulting firm Lewin Group. Eighty percent of those surveyed by the group in their analysis of the first year of the program said they were very or somewhat satisfied with their experience.

The program covers hundreds of thousands of people in Indiana, Lewin Group found, and 92 percent of those in one section of the program continued making contributions, which Verma argued shows that “members recognize and appreciate [HIP’s] value.” Of those who left the program, just five percent said it was due to affordability, while over half said they moved to private health insurance.

New GOP Gov. Eric Holcomb has submitted a waiver to the Trump administration to keep the program going through 2021. He wrote to federal officials in January that over 400,000 are now covered by the program.

Verma and her firm SVC also worked with Iowa, Ohio, Michigan and Kentucky on their proposals for Medicaid waivers, as well as designing Tennessee’s Medicaid expansion, according to SVC’s website.

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