Seema Verma is a bold pick by President Trump to head the Centers for Medicare and Medicaid Services. She should be approved without further delay.
During a hearing by the Senate Finance Committee this week she appeared confident and informed, refusing to take positions on raising Medicare’s eligibility age, price negotiation with drug companies, or caps on Medicaid allotments to the states. She stated that these decisions are up to Congress, showing an understanding of her role’s limits.
At the same time, she wouldn’t support converting Medicare to a private voucher program, a change which Speaker Paul Ryan has supported and could undermine the longtime concept of Medicare as a reward for years of work and taxes. Verma also said that Medicaid needs an overhaul, something that physicians have known for a long time. In fact, almost one-third of physicians nationwide do not accept new Medicaid patients.
She also took a courageous and defining stand against mandatory maternity benefits – part of the Essential Benefits package of ObamaCare. As crucial as these benefits often are for child-bearing women, sharing them across all policies increases premiums for those who will never have children, which isn’t equitable. Verma’s opposition, though unpopular among most Democrats, reflects a serious commitment to flexibility, choice and overall cost savings in health insurance.
Verma received a master's in Public Health from Johns Hopkins and is the founder and CEO of SVC Inc., a health policy consulting firm that was instrumental in guiding the Medicaid expansion under then-Gov. Mike Pence in Indiana.
Verma and her firm helped create and oversee the implementation of Healthy Indiana Plan 2, which includes catastrophic coverage, high deductibles and Health Savings Account contributions. It introduces an innovative strategy of participation into a program that has always been viewed exclusively as an entitlement. HIP 2 includes pathways to jobs and increased reimbursements for physicians, designed to encourage physician participation. Verma also has been advising Kentucky on adding a work activity requirement for their Medicaid expansion program.
Focusing on patient participation and pay-for-service as part of a Medicaid expansion may seem austere and cold when dealing with poor people who are already struggling to survive, until you consider the vast numbers of Medicaid patients who are afraid to take a job for fear of losing their coverage. Entitlements are job killers. Medicaid, though it has saved countless lives, can also be a disincentive to work. Verma’s approach, by contrast, can provide a bridge to employment without risking health coverage.
Medicare and Medicaid recipients do not always think about their coverage the same way that we physicians do. When it comes to Medicare, for example, primary care doctors like me tend to consider how long it will take to see a patient, how long his problem list is, and whether his tests, treatments, or my specialist of choice (for a colonoscopy, surgery etc.) will accept his Medicare. Whereas the patient is understandably thinking of his pressing health needs and how to get them taken care of. This frequently leads to a clash between my patient’s expectation and what I can reasonably deliver. The same is true for Medicaid, which provides a large array of services. I am not the only internist, for example, who has had a Medicaid patient hospitalized with a life-threatening infection ask for a new pair of eyeglasses (covered by Medicaid) before discharge.
Don’t get me wrong, I completely understand that for many, Medicare and Medicaid represent the only buffer they have against illness and death. As a doctor I must take this extremely seriously and never be dismissive. Medicaid and Medicare are an enormous part of our health care system. It isn’t an accident that more of the National Health Expenditure is due to these two insurances combined (37 percent or $1.2 trillion in 2015) than to private insurance (33 percent or $1 trillion in 2015).
If Seema Verma, once confirmed, manages to add more choice, incentives, participation and bridge-to-jobs to Medicaid while supporting congressional attempts to make Medicare more efficient and user-friendly while preserving its integral purpose, her skills and leadership will be welcomed and even applauded.