Seema Verma has a plan—and it's to cut Medicaid, which she believes should never have been expanded.
According to a report in Stat, Trump's administrator of the Centers for Medicare and Medicaid Services has plans to make "sweeping changes" to Medicaid that could slice enrollments and cut costs without congressional approval.
Verma is quoted in the report saying that states will be given an "unprecedented level of flexibility" to design their Medicaid programs as they see fit. At the Cleveland Clinic's annual medical innovation summit, Verma said she would cut scrutiny of state requests for waivers from federal rules meant to preserve access and quality standards.
Recommended For You
However, Verma's view of the Medicaid expansion that took place under the Affordable Care Act is that it never should have happened, extending coverage to millions of low-income people who shouldn't be getting insurance from the government.
"We've put more than 10 million people, 12 million people into this program where the doctors won't see them, and the policies that are in the Medicaid program are not designed for an able-bodied individual," Verma says in the report, adding that the administration's goal is to keep those people in the private insurance market, where they would not be "dependent on public assistance."
Since Republicans have thus far been unsuccessful at passing a repeal-and-replace law to remove the ACA, Verma appears determined to take the Trump approach—to dismantle it via administrative actions.
Prior to her tenure at CMS, Verma helped states create plans that made Medicaid coverage conditional on payment of premiums by beneficiaries, as well as an employment requirement for them to retain coverage. According to the report, [s]he is best known for her work on an Indiana plan that requires enrollees to make income-based contributions to a health savings account that's akin to a premium. Failure to pay means losing benefits or coverage."
Hospitals that have accepted federal reimbursement cuts in exchange for broader coverage of low-income patients could be hard hit by the changes Verma plans, and access to coverage could be restricted by the states under such changes as well.
"The federal rules are in place to make sure basic access and quality standards are met," Julie Donohue, director of the Medicaid Research Center at the University of Pittsburgh, says in the report. "The devil is really in the details in terms of how much additional flexibility to give to states and whether we start to get concerned about those basic minimum federal standards being met."
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
