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New Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma and Health and Human Services Secretary Tom Price sent a letter to the nation's governors encouraging them to consider reforms to Medicaid such as making recipients pay insurance premiums. (Photo: Stephen Melkisethian/flickr/cc)

Trump's New Medicaid Head Wastes No Time Urging States to Make System More Cruel

Seema Verma was architect of program in Indiana that imposed "unprecedented co-payments and premiums."

Andrea Germanos

As Republicans push to gut Medicaid, the safety net program's new administrator quickly made clear that parts of the "punitive" plan she crafted for Indiana's Medicaid recipients are what she hopes other states will replicate.

After her swearing in Tuesday, Centers for Medicare and Medicaid Services (CMS) head Seema Verma and Health and Human Services Secretary Tom Price sent a letter (pdf) to the nation's governors stating their commitment "to ushering in a new era for the federal and state Medicaid partnership where states have more freedom to design programs that meet the spectrum of diverse needs of their Medicaid population."

The plan they sketch out includes letting states impose insurance premium requirements and emergency room co-payments and leading recipients towards features similiar to Health Savings Accounts and pushing "skills and employment."

As The Atlantic wrote last month:

Verma is best-known for her role in reshaping the Indiana Medicaid program under then-Governor Mike Pence. Despite Pence being an ardent critic of Obamacare, Indiana made the choice to expand Medicaid anyway. But they utilized a pathway known as the 1115 waiver to craft a program that diverged significantly from the guidelines under the standard Obamacare program, and quickly created the most conservative Medicaid expansion program in the country. That program, known as the Healthy Indiana Plan 2.0, was the brainchild of Verma and her health-care consulting company, SVC, Inc, then recommended as an experienced expert and consultancy firm with knowledge of the minutiae of CMS regulations.

Decrying her for being "the architect of Indiana's punitive restrictions on Medicaid patients," Dr. Robert Zarr, president of Physicians for a National Health Program, warned previously that

[h]er plan forced impoverished Medicaid enrollees to pay dearly for care, imposing unprecedented co-payments and premiums on people with little chance of affording them; those who miss a payment are denied coverage. Her actions in Indiana signal that she will inflict cruel and unusual punishment on America's most vulnerable citizens.

Her work on Medicaid in the Hoosier State was also noted by Senator Maria Cantwell (D-Wash.), who said Verma there "made millions of dollars in consulting fees by kicking poor, working people off of Medicaid for failure to pay monthly contributions similar to premiums," the New York Times wrote.

In addition to her involvement in Indiana, The Atlantic added that

Verma's consultancy was also involved in a failed attempt in Ohio to bar Medicaid recipients from coverage until they'd paid premium arrears, and in the use of an 1115 Medicaid waiver in Kentucky to create a 'work activity' requirement for the program. That waiver is still under consideration by CMS, and will be under her own review should she become administrator.

The letter comes as the Republican plan dubbed TrumpCare would phase out the Medicaid expansion made possible through Obamacare—an expansion derided by Verma and Price in their letter. Beyond that, the GOP proposal would make "changes to Medicaid that would significantly affect coverage and financial security for over 70 million low-income Americans—including children, seniors, and people with disabilities—and increase uncompensated care for hospitals," Jessica Schubel, senior policy analyst at the Center on Budget and Policy Priorities, writes Wednesday.

Specifically, she writes, it would

  • Roll back Medicaid coverage for children ages 6 to 18;
  • Make it harder for seniors and people with disabilities to qualify for Medicaid and get care in their homes and communities;
  • Increase the likelihood of medical bankruptcy for low-income people and increase uncompensated care for safety net hospitals; and
  • Speed up effective repeal of the ACA's Medicaid expansion by requiring states to redetermine the eligibility of expansion beneficiaries every six months.

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