If you’re tired of hearing about the usual cast of appalling characters in the Trump-Pence administration, here’s a powerful player who may have flown under your radar: Seema Verma.
Seema Verma is one of many Trump-Pence officials whose experience comes mostly from dismantling the very programs that she was appointed by the president to run. A wealthy corporate health care consultant who made millions of dollars helping former Indiana Governor Mike Pence dismantle Medicaid in the state, Verma has led the Centers for Medicare and Medicaid Services (CMS) nationwide since 2017.
At CMS, Verma’s top priority seems to be the opposite of the agency’s responsibility to provide access to quality and affordable health care. Instead, Verma appears obsessed with taking affordable health care coverage away from people with low incomes, while acting as if she’s doing them a favor.
At the same time, Verma has racked up a reputation for using taxpayer funds to pay for expensive things that benefit her — like public-image consulting and reimbursement for outrageously expensive jewelry stolen on a business trip.
We could write pages on how hypocritical Verma is and how dangerous her policies are. But we’ll distill it to the seven worst things that she’s done to attack people’s health care
1) Seema Verma helped Mike Pence undermine Medicaid in Indiana.
Throughout her career, Verma has erected roadblocks to health coverage for people with low incomes. She helped Pence craft a 2014 program that increased Medicaid costs for Indianans — and from 2015 to 2017, about 25,000 Indianans with low incomes lost access to Medicaid.
Verma likes to paint herself as the savior of people she harms. She had the gall to say that her restrictive Medicaid program helped Indianans with low incomes learn — seriously — “personal responsibility.” After Verma earned a reputation as Pence’s anti-health care protégé, he persuaded Trump to place her at the helm of CMS. Verma now plays a role in how every state administers essential health coverage for millions of people in the United States.
2.) Verma gave the green light for massive Medicaid cuts by encouraging states to use a “block grant” system.
Under Verma’s direction, CMS has made an audacious move to let states overhaul how Medicaid works and gut funding for the program. CMS could let states opt out of traditional Medicaid, and instead use a “block grant” system — paving the way for states to cut health care services and kick people with low incomes off their health insurance. In particular, it could lead to fewer people enrolling in Medicaid, fewer services covered under Medicaid, and health care providers getting paid less for accepting Medicaid reimbursements (which would stop some providers from accepting Medicaid patients).
Simply put, a block grant system is designed to kick Medicaid users off the rolls. That’s why doctors and leading medical groups oppose it. To overcome this opposition, the administration has titled this initiative the “Healthy Adult Opportunity” program — as if the risk of losing one’s health insurance were an opportunity. That type of flim-flam hasn’t fooled anyone, and medical groups and doctors still oppose it.
The millions of low-income people who obtained coverage under the Affordable Care Act’s (ACA) Medicaid expansion are most at risk of losing their coverage under a block grant system. But states could decide to target even more Medicaid users — such as certain pregnant people and low-income parents whose coverage is not required by federal law. People of color, who already face systemic barriers in accessing quality health care, stand to bear the brunt of any block grant systems approved under Verma’s policies.
3.) Verma has pushed harmful work requirements, which are designed to boot people off Medicaid.
Verma has supported deceptive “work requirements” — which sound okay, but whose actual purpose is to make it harder for people to keep their health coverage. These requirements take coverage away from people if they don’t regularly report their work activities through reporting procedures, which are often so tedious and difficult to navigate that they can be impossible to use — particularly for people who lack internet access, don’t speak English, or don’t know about the requirements.
Twenty states have proposed work requirements or instituted them: CMS has approved work requirements in seven states, and is reviewing proposals from 10 states. In another three states, work requirements have been approved, but are on hold due to litigation.
People are already feeling the damage of work requirements. After Arkansas imposed work requirements, nearly one-third of Medicaid enrollees (about 18,000 people) lost coverage. These consequences have spurred numerous lawsuits against the administration, including an Arkansas case in which a federal court ruled to block work requirements in the state due to the harm they caused.
4.) Verma has emboldened states to “defund” Planned Parenthood.
A little background for this one: Several years ago, Texas ended its federal Medicaid family-planning program and started a state-run one in order to bar people with low incomes from getting care at Planned Parenthood. Nearly 45,000 people lost access to preventive, reproductive health care — because Planned Parenthood had been providing 40% of services. Now that the federal government is led by people who share this anti-Planned Parenthood agenda, Texas has asked CMS if the state could continue blocking patients from Planned Parenthood, but once again use federal funding.
CMS said yes.
On Jan. 22, Verma permitted Texas to receive federal Medicaid funding for its state family planning program, even though the program bars patients from accessing preventive care at Planned Parenthood health centers. The move upended longstanding federal law that had protected Medicaid users’ right to choose their own qualified reproductive health care provider, which includes Planned Parenthood health centers. By supporting Texas’ program to block Medicaid patients from Planned Parenthood, the administration opened the floodgates for other anti-abortion states to follow suit — putting health care at risk for people across the country.
It’s devastating, but it’s no surprise. Early in Verma’s tenure, CMS stopped reminding states that people can use their Medicaid coverage to access preventive care at Planned Parenthood health centers. Instead, CMS emboldened state Medicaid directors to “defund” Planned Parenthood and exclude Planned Parenthood health centers from Medicaid reimbursement.
What’s more, Verma has pushed anti-Planned Parenthood messaging for years. She once called it “an important step” to block patients who rely on federal programs like Medicaid from accessing preventive care at Planned Parenthood health centers.
5.) Verma is in charge of many pregnant people’s health insurance — but opposes guaranteed maternity health coverage.
Showing how out-of-touch she is, Verma said she thinks maternity coverage should be optional for insurance companies to include in their plans. When asked if maternity coverage should continue to be included in insurance plans, as the ACA requires, Verma said insurance companies could force people to pay extra for it.
Verma doesn’t seem to care that treating maternity coverage as an add-on would make plans less affordable, and could have negative consequences for women with low incomes — particularly in cases of unplanned pregnancies.
6.) She exploits her position for her personal gain — and her exploitation is tacky and expensive.
Trump arguably isn’t the only person in the administration who makes self-promotion a top priority. Verma has used taxpayer dollars to make herself look good — directing millions in federal funds to hire external PR consultants to polish her reputation. That’s right: she spent public money on work done for her personal benefit.
It gets worse. While making public appearances to promote her plans to take away health care, Verma reported that $47,000 worth of jewelry and other luxury items were stolen from her. She filed a claim to the U.S. Department of Health and Human Services to get her losses reimbursed — including, in her filing, a request for $5,900 for an Ivanka Trump-brand pendant. (HHS chose not to reimburse her for the full amount.)
But that’s not all: Verma’s Trump-brand pendant cost a mere $200 more than an entire year’s worth of Medicaid coverage for one person. (We’re just barely repressing the urge to insert a very foul emoji right here.)
7.) She called Medicaid “mediocre,” when it’s anything but.
You’d think the person in charge of Medicaid would speak about the program in a respectful — or at least accurate — way. Not Verma. In February, Verma bemoaned the cost of Medicaid and said: “Yet, for all that spending, health outcomes today on Medicaid are mediocre and many patients have difficulty accessing care.”
In fact, study after study shows that access to Medicaid IMPROVES health outcomes. A Kaiser Family Foundation meta-analysis of 300 studies showed that Medicaid expansion led to lower mortality rates for people with heart disease and shorter hospital stays overall. A recent report by the Robert Wood Johnson Foundation confirmed those findings — associating Medicaid coverage with decreased hospital and emergency department utilization and decreased infant, child, and adult mortality rates, as well as higher rates of preventive health screenings, lower likelihood of delaying care because of costs, and more positive health behaviors and outcomes.
Here’s what should be clear to Verma, despite her fixation on restricting access to health care: Medicaid coverage saves lives. Thanks to the ACA, nearly 20,000 adults in the United States between ages 55 and 64 — according to a study by the Center on Budget Policy and Priorities — owe their lives to getting affordable Medicaid coverage between 2014 and 2017.
The big picture: Verma’s attacks on Medicaid are attacks on women of color.
A big part of Verma’s job is running Medicaid — which is perhaps THE most significant reproductive health care program in the United States:
- Women and girls are the majority of Medicaid’s 75 million enrollees.
- Medicaid covers more women’s health care than any other payer.
- Nationwide, Medicaid covers one in five of all women and girls of reproductive age.
- Medicaid covers more than 40% of all U.S. births [PDF], and 75% of family planning services.
But how has Verma used her position? To undermine health coverage — and to make it harder for people with low incomes to obtain care.
And why is this important to know? Because limits on Medicaid hurt women of color in particular. Due to racism and other systemic barriers that contribute to enduring economic inequities, women of color disproportionately make up the Medicaid population. They're roughly 57% of women in the program — while women of color make up only 37% of the female population of the United States.
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Since taking office, the Trump-Pence administration has pushed policy after policy that strips away people’s basic health and rights — and they’re hoping we won’t notice until it’s too late. Trump, Pence, and their band of bad actors have worked tirelessly to keep these unpopular policies under the radar and out of the news. But we’re not going to let them.