Senate prepares to hear Seema Verma, Trump's ACA boss pick

The Senate Finance Committee will ramp up Affordable Care Act change talk next week, by holding a hearing on Seema Verma at 10 a.m. Thursday.

Verma, an Indiana health policy consultant, is President Donald Trump's pick to be the next administrator of the Centers for Medicare & Medicaid Services. CMS is the federal agency directly in charge of Medicare, Medicaid, the ACA exchange system, HealthCare.gov and the ACA rules and programs that affect the traditional commercial health insurance market.

As the head of CMS, Verma, for example, would have a role in deciding how insurers should handle health insurance agent and broker compensation payments when filing ACA medical insurance medical loss ratio reports.

The Senate voted 52-47 at 1:46 a.m. Thursday to confirm Tom Price of Georgia, an orthopedic surgeon who has been representing Georgia in the House, to be Trump's secretary of the U.S. Department of Health and Human Services. HHS is the department in charge of CMS.

The Senate is preparing to vote on confirming Steven Mnuchin, an investment banker who is Trump's pick to the next Treasury secretary, Monday. As the cabinet secretary in charge of the Internal Revenue Service, Mnuchin would also play a major role in shaping ACA policies, and any post-ACA policies.

The Senate Health, Education, Labor and Pensions Committee is preparing to hold a hearing on Trump's Labor secretary nominee, Andrew Puzder, at 10 a.m. Thursday, while Verma is taking questions at the Senate Finance hearing. Puzder, a restaurant company executive, would be yet another major Trump administration health policy player.

But Verma is the only one of those four people who has direct experience with government health insurance programs.

Seema Verma talked about Indiana's Medicaid program changes in July 2013 at the OtherCare: Liberation & Innovation in American Healthcare conference in Ann Arbor, Michigan. Rebel MD posted a video of the session on YouTube in November.

HIP Plus POWER accounts

Seema Verma has a bachelor's degree from the University of Maryland at College Park and a master's degree in public health from Johns Hopkins University. She started out working as a planner in the Health & Hospital Corp. of Marion County in Indiana.

As a consultant, Verma helped Indiana set up the Healthy Indiana Plan 2.0. The plan provides Medicaid coverage for state residents ages 19 to 64 to earn less than 138 percent of the federal poverty level who would do not qualify for Medicare or traditional Medicaid.

For eligible people who pay a monthly premium of a few dollars per month for the HIP Plus version of the plan, Indiana will put $2,500 in a Personal Wellness and Responsibility Account, or POWER account.

If HIP Plus enrollees pay their premiums and have medical expenses under $2,500, they can roll their remaining contributions over to reduce the required contributions for the following year. The rollover amount will be doubled if the enrollees get all recommended preventive services.

Verma has given many presentations on the HIP Plus program, including a conference on the ACA Medicaid expansion program that the Federal Reserve Bank of Chicago and the Civic Federation of Chicago held in April 2016.

In July 2013, she described the HIP Plus POWER accounts as being the equivalent of "health savings accounts" for the poor at a health care innovation conference in Ann Arbor, Michigan. She said she believes the use of HSA-like accounts helps Medicaid enrollees increase the amount of value they get from their care.

"By having some kind of savings account, it engages people," Verma said, according to a YouTube video of the presentation posted by Rebel MD.

Other states, such as Iowa and Arizona have copied or intend to copy the Indiana program.

Dr. Don McCanne of the Physicians for a National Health Program, a Chicago-based group that says the United States should adopt a universal, government-run, government-paid health care system, has criticized Verma in commentaries on the PNHP website. He has argued that she would be an ideologue who would push too hard to increase patients' out-of-pocket costs, or "skin in the game."

Tom Price testified at a Senate hearing in January that many patients' out-of-pocket costs are now too high.

Verma has reported in HIP Plus presentations that enrollee satisfaction survey results and re-enrollment rates are high; that tying account value rollover amounts to use of preventive care pushes preventive care use rates up to about 80 percent; and that about 30 percent to 35 percent of the account users ask physicians how much care costs.

Verma also knows about the ACA. Her consulting firm, SVC Inc., had the contract to train Indiana HealthCare.gov navigators, or ombudsmen, how to be navigators. The firm developed videos on topics such as how to calculate required premium contribution levels for exchange plan coverage.

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