If confirmed as Centers for Medicare & Medicaid Services administrator, Seema Verma vowed to modernize CMS programs, improve Medicaid access, and leverage technology to drive better care, but she stopped short of explaining how she would do so during her confirmation hearing Feb. 16 before the Senate Finance Committee.

Legislators grilled Ms. Verma on Medicare improvements, the fate of the Affordable Care Act (ACA), Medicaid reform, and the execution of value-based care. At every turn. Ms. Verma pledged to review current processes and work toward enhancing programs, but she declined to support or oppose specific changes. Instead, she promised to help make health care more affordable and to allow patients more flexibility in making health insurance decisions.

“I am deeply concerned about the state of our health care system,” Ms. Verma said during the hearing . “Many Americans are not getting the care that they need, and we have a long way to go on improving the health status of Americans. Doctors are increasingly frustrated by a number of costly and time-consuming burdens. I want to be part of the solution, making sure that the health care system works for all Americans. … Patients and their doctors should be making decisions about their health care, not the federal government. We must find creative ways to empower people to take ownership of their health.”

Much of the committee’s questioning centered on Ms. Verma’s work on the Healthy Indiana Plan (HIP), Indiana’s Medicaid expansion under the ACA. The conservative plan requires patients to pay a small amount to receive health coverage and includes a lockout period if payments are missed. Legislators repeatedly asked if Ms. Verma planned to use HIP as a model to alter the Medicaid program.

Ms. Verma countered that each state has different needs and should be allowed to develop individualized Medicaid programs that provide flexibility.

“This is about putting states in a leadership role so that they can manage their programs better,” she said. “States are closer to the people that they serve and have a better understanding of what can work in their state than the federal government. I think states should have that flexibility.”

Legislators raised concerns about Ms. Verma’s past consulting agreements with states while working for Hewlett Packard (HP), a company that had financial interests in the health programs she designed. Ms. Verma’s company, SVC, advises clients on Medicaid waivers and state plan amendment development.

“It is hard to see how it is OK to basically orchestrate state health programs and then get paid by the contractors the state hires to carry out those very programs,” said Sen. Ron Wyden (D-Ore.), ranking member of the Senate Finance Committee. “How is this not a conflict, because you were sitting, in effect, on both sides of the negotiating table?”

Ms. Verma argued that she never negotiated on behalf of Hewlett Packard, and that the work she conducted for the states did not overlap with work she completed for HP. Her company sought an ethics opinion to ensure the arrangement was not problematic, she said.

“I hold honesty and integrity and adherence to a high ethical standard as part of my personal philosophy. That’s for me, I demand that from my employees, and I set that example for my own children,” she said. “We were never in a position where we were negotiating on behalf of HP or any other contractor with the state that we had a relationship with. If there was the potential [for a conflict], we would recuse ourselves.”

Ms. Verma dodged many specific questions, including whether she supported block grants for Medicaid, how she might improve the problem of prescription drug prices, and whether she supported Medicare as a voucher program. When asked by Sen. Sherrod Campbell Brown (D-Ohio) whether she supported an extension of the current Children’s Health Insurance Program (CHIP) for another 8 years, Ms. Verma said she supported “the reauthorization of CHIP for as long as possible.”

When asked about the value-based reforms included in MACRA (the Medicare Access & CHIP Reauthorization Act of 2015), Ms. Verma said she applauded passage of the law, but she would not go into detail about potential changes to the statute.

“I think it’s an important step forward, not only to providing more stability for providers, but also moving us to better outcomes,” she said.

Sen. Wyden grew visibly frustrated with Ms. Verma’s vague answers, saying he was disappointed that, after many questions, the stances she took in many areas were still unclear.

“You’ve been asked a lot of questions and they were not ‘gotcha’ questions,” Sen. Wyden said during the hearing. “These were questions that were appropriate given the fact that if you’re confirmed, you’re going to head an agency that’s involved with a trillion [dollars] of spending in the health care of 100 million people. We’re not really getting much of a sense of how you’d approach [these issues]. I think this committee needs answers and I think the public needs answers.”

Finance Committee Chairman Orrin Hatch (R-Utah) praised Ms. Verma at the close of the hearing, calling her an experienced professional who will bring about needed change to CMS.

“It is critical that we get a strong, skilled leader as CMS administrator,” he said. “Here you are, somebody who has proven to be a tremendous leader in health care, not only to Indiana but as an example to the rest of the states. All I can say is you will be a strong, skilled leader as CMS administrator.”

A relative unknown before her nomination, Ms. Verma spent 20 years designing policy projects involving Medicaid, including HIP, the nation’s first consumer-directed Medicaid program under Indiana Governor Mitch Daniels and then-Gov. Mike Pence’s HIP 2.0 waiver proposal.

Prior to consulting, Ms. Verma served as vice president of planning for the Health and Hospital Corporation of Marion County (Ind.) and as a director with the Association of State and Territorial Health Officials in Washington.

Senators have asked that Ms. Verma submit written answers to their questions, which they will review before voting on her nomination.

On Twitter @legal_med


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