President Donald Trump's pick to run the government's major health insurance programs said Thursday that Medicaid needs a full overhaul—but that she doesn't support turning Medicare into a "voucher" plan.
Indiana health care consultant Seema Verma testified before the Senate Finance Committee on her nomination to lead the Centers for Medicare and Medicaid Services, or CMS. The $1 trillion agency oversees programs that cover about 1 out of 3 Americans.
Verma, 46, is a protégé of Vice President Mike Pence, having designed a Medicaid expansion plan along conservative lines for Indiana when he was governor. Her successful consulting business has about a dozen staffers, and if confirmed, she would run an agency with nearly 6,500 employees.
At the hearing, Verma played a cat-and-mouse game with Democratic senators, offering some clues as to her thinking but also deflecting many questions. Sen. Ron Wyden of Oregon, the ranking Democrat on the panel, later called the exercise "a missed opportunity for the nominee."
Republicans praised her performance, but two GOP senators said they were very concerned that revamping Medicaid could leave tens of thousands uninsured in their states.
The federal-state program for low-income people, Medicaid covers more than 70 million Americans, from pregnant women and newborns, to elderly nursing home patients. It was expanded by the Obama-era health law to cover more low-income adults. House Republicans want to cap federal financing and turn control of Medicaid over to the states, eliminating most requirements from Washington.
"The status quo is not acceptable," Verma said of Medicaid. "We can do a better job...we know we are not delivering great health outcomes."
Pressed by senators on whether she would support capping the program and turning it into a block grant, she stopped just short of endorsing such an approach.
"I am endorsing the program being changed to make (it) work better for the citizens that rely on it," she said.
The Medicaid expansion Verma designed in Indiana uses financial rewards and penalties to steer low-income residents to front-line primary care providers rather than the emergency room. Critics say it's been confusing for beneficiaries, and some have incurred penalties through no fault of their own. A proposal she developed for Kentucky includes work requirements for most adults.
In defense of her approach, Verma said low-income people are fully capable of making their own decisions.
On Medicare, which covers seniors and disabled people, Verma said "I'm not supportive" of turning it into a voucher plan. That's a term used by critics to describe a proposal under which retirees would get a fixed payment to purchase coverage from government-regulated private insurance plans.
Prominent advocates include House Speaker Paul Ryan and newly confirmed health secretary Tom Price. They call it "premium support."
Verma deflected other questions, including whether she would support Medicare negotiating drug prices directly with manufacturers—a position the president has sometimes backed.
At CMS, Verma would also oversee coverage under the 2010 health care law.
Asked by Sen. Debbie Stabenow, D-Mich., if she supports the law's requirement that insurance plans cover maternity and newborn care, Verma said some women want maternity coverage and "some women might not choose that." Physicians groups say maternity should be a mandatory benefit because about half of U.S. pregnancies are unplanned.
A Finance Committee vote on Verma's nomination is not expected for at least a week. She seems on track to be approved by the full Senate.