On Tuesday, President-elect Donald Trump tapped Seema Verma, a health care consultant, to head the Centers for Medicare and Medicaid Services. That鈥檚 the part of the Department of Health and Human Services that oversees Medicare, Medicaid, and the Children鈥檚 Health Insurance Program and has a budget of in 2016.
Verma comes to the job with extensive Medicaid experience. Her consulting firm, SVC, Inc., worked closely with Indiana Gov. to design Indiana鈥檚 Medicaid expansion under the Affordable Care Act. The expansion, known as the Healthy Indiana Plan or HIP 2.0, went into effect early last year, and Verma鈥檚 involvement may be important as Congress and the Trump administration, including the vice-president elect, make decisions on the future of the ACA.
Indiana鈥檚 unique Medicaid expansion was designed to appeal to conservatives. HIP 2.0 asks covered people to make a small monthly payment to access health insurance. A missed payment can result in six-month lockout from insurance coverage. Those provisions aren鈥檛 allowed under traditional Medicaid, but Indiana got special permission from CMS to implement them through a waiver.
Other Republican-led states such as Iowa, Ohio and Kentucky, have contracted with to help submit their own Medicaid expansion proposals to the federal government that also include conservative provisions such as asking recipients to pay for some of their care, or requiring them to work or be actively looking for work.
Susan Jo Thomas, who heads the Indiana insurance advocacy group , said Verma鈥檚 contributions to HIP 2.0 made Medicaid expansion possible in a Republican state. 鈥淪he understood that in order to get expansion in this state,鈥� she said. 鈥淚t鈥檚 more about what is palatable, what can get approved.鈥�
Nearly 410,000 people are members of HIP 2.0, according to the latest data from the state.
But HIP 2.0 has its critics. , a policy analyst with the National Health Law Program, which advocates for health care for low-income individuals, argued that the cost-sharing provisions or if a person is temporarily removed from Medicaid actually reduce participation in the program. 鈥淓arly evaluations show that a lot of people don鈥檛 understand this plan and don鈥檛 understand the incentives in it,鈥� he said. That means people end up not getting the health care they need.
Nevertheless, Machledt said if Medicaid expansion continues, Verma鈥檚 pick to head CMS could mean that proposals similar to Indiana鈥檚 may be more likely to be approved.
with the Georgetown Center for Children and Families agrees, and finds it worrisome. 鈥淚t is a good thing that she has experience with Medicaid and it is a positive that Governor Pence worked with Ms. Verma to advance a version of Medicaid expansion,鈥� she said. 鈥淏ut I think if you look at the totality of the Trump administration鈥檚 picks today 鈥� Congressman Price as well as Ms. Verma 鈥� this represents potentially a very damaging and chaotic restructuring of the Medicaid program.鈥� Price has advocated severely cutting Medicaid funding, and Alker worries that cuts and more stringent requirements under Verma mean people will lose the health insurance.
鈥淭he Healthy Indiana Plan has occurred in the context of generous federal funding,鈥� she said. 鈥淎nd I think some of that is on deck to go away.鈥�
But Verma may be a smart pick, said Indiana Rep. Charlie Brown, the ranking Democrat in the state鈥檚 public health committee. 鈥淪he is a smooth operator, and very, very persuasive,鈥� he said. Brown worked in opposition to Verma in crafting the Healthy Indiana Plan, but said she worked effectively across party lines to incorporate the Pence administration鈥檚 wishes into the program.
鈥淪he鈥檚 very resourceful and intelligent,鈥� said Brown. 鈥淏ut the question now becomes, 鈥榃hat will be her marching orders as they relate to Medicare and Medicaid?鈥� 鈥�
Verma鈥檚 role in shaping Indiana鈥檚 health care policy has had some controversy. According to a 2014 from The Indianapolis Star, she has received millions of dollars from the state through her work with the Indiana government. She was also paid by Hewlett-Packard, a Medicaid vendor that received more than $500 million in state contracts. Government ethics experts told the Star the arrangement presented a conflict of interest.
Verma did not immediately respond to requests for comment, nor did Gov. Pence鈥檚 office.
This story is part of a reporting partnership with , and Kaiser Health News.