Critic of Medicaid confirmed to lead program; urges governors to alter program along her lines

Seema Verma at Senate hearing
(Getty Images)

The newly confirmed director of the Medicaid program quickly served notice that she wants states to make changes like those she has helped make in Indiana, her home state and that of Vice President Pence, including work requirements.

The Senate by a 55-43 vote on Monday confirmed Seema Verma, an Indiana health care consultant and Pence protégé, to run the Center for Medicare and Medicaid Services. Verma, a first-generation American whose parents emigrated from India, will lead "a $1 trillion agency that oversees health insurance programs for more than 130 million people, from elderly nursing home residents to newborns," Ricardo Alonso-Zaldivar reports for The Associated Press.

On Tuesday Verma and Health and Human Services Secretary Tom Price sent a letter to governors, "urging states to alter the insurance program for poor and disabled people by charging them insurance premiums, requiring them to pay part of emergency room bills and prodding them to get jobs," Amy Goldstein reports for The Washington Post. The letter "also derides the Medicaid expansion that 31 states and the District of Columbia adopted under the Affordable Care Act."

The letter says "the expansion, which has extended Medicaid to 11 million people with incomes of up to about $16,000 for a single person or nearly $34,000 for a family of four, 'was a clear departure from the core, historical mission of the program," Goldstein writes. "By giving states greater help with these new beneficiaries, it contends the ACA has 'provided states with an incentive to de-prioritize the most vulnerable populations.' The three-page letter does not mention that, for the first three years, the federal government paid the entire cost of covering the expansion group and still pays nearly all of that," 95 percent this year, and scheduled to decline to 90 percent by 2020.

Beginning in 2020, the House Republican health-care bill backed by President Trump "would limit overall federal financing for Medicaid in the future. Taken together, those changes could leave 24 million more people uninsured by 2026, the Congressional Budget Office said Monday in an assessment." The impact would be greater in rural areas, The Wall Street Journal reports. To see a Democratic-compiled rundown of how CBO thinks the bill would affect each of the 435 congressional districts, click here.

"In Indiana, Verma designed a Medicaid expansion along conservative lines for Pence. Most beneficiaries are required to pay modest premiums. And the program uses financial rewards and penalties to steer patients to primary care providers instead of the emergency room. Critics say the plan has been confusing for beneficiaries and some have incurred penalties through no fault of their own," AP reports. "At her Senate confirmation hearing, Verma defended her approach by saying that low-income people are fully capable of making health care decisions based on rational incentives."

Verma also helped design a similar plan that Kentucky has asked the agency she now heads to approve.