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Seema Verma - Administrator, Centers for Medicare & Medicaid Services

Updated: Feb 28, 2023

September 2017

Obamacare expanded the Medicaid program in 2014 so that millions of adults, many of whom don’t have children, could newly qualify for care under the health coverage program for the poor. And since then, it has been in the crosshairs of conservatives who see it as an out-of-control entitlement. When President Donald Trump picked Seema Verma to be head of the U.S. Centers for Medicare & Medicaid Services—the $1 trillion agency overseeing health programs that insure more than 130 million Americans—he named the person who has already done as much as anyone to give Republicans around the country the ideas to pare it back.

It started in Indiana: During Vice President Mike Pence’s tenure as governor, Verma was a health consultant who developed an approach to inject some free-market spirit into the Obamacare Medicaid expansion that took effect there in 2015. Under her plan, Indiana added costs for low-income patients who enrolled, as well as job search incentives and coverage lockouts for people who missed monthly payments. That work also helped her score gigs with GOP officials in Kentucky, Ohio and Iowa, among other places, looking to use their state-level powers to clamp down on what they saw as a swelling federal giveaway.

To Verma, Medicaid is a program meant to be preserved for society’s most vulnerable, and if less needy populations are getting coverage, they need to pay more to have it. Medicaid’s “rigid, complex rules designed to protect enrollees have created an intractable program that does not foster efficiency, quality or personal responsibility for improvement in health status,” she told members of Congress in 2013.

Now, Verma leads a 6,500-person federal bureaucracy that oversees not just Obamacare but Medicare for seniors and Medicaid for the poor. She has promised more flexibility for states to experiment with new Medicaid approaches that would let them skirt federal requirements, and signaled a willingness to greenlight policy ideas she helped shepherd in Indiana. Some states are already jumping at the chance—with Kentucky, Maine, Wisconsin and others seeking federal approval for significant changes. As a result, under Verma’s oversight, Medicaid could look quite different, whether or not Obamacare remains the law of the land. —Rachana Pradhan

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