Wayne O'Leary

The Woman Who Would Kill Health Care

Slowly but surely, many of the very worst of the Trump administration’s seamy cast of characters have begun to exit the scene of their transgressions as sunlight, the best disinfectant, gradually penetrates the dark corners where they’ve done their worst. The dearly departed include extremist ideologues, out-and-out incompetents, shameless kleptocrats, and primeval swamp creatures.

Steve Bannon, conjurer of the mythical “deep state,” is gone from the White House, though he keeps trying to return by flattering the resident ego in the Oval Office. Rex Tillerson is gone from the State Department, having let it virtually die of neglect. Tom Price is gone from the Department of Health and Human Services, after turning his agency into a personal travel bureau for luxury jaunts at public expense. And Scott Pruitt has left the crippled Environmental Protection Agency, after making his tenure synonymous with sleaze and petty corruption in government.

But many lower-profile conservative sycophants have remained in position to do lethal damage by burrowing deep into the recesses of Trump’s Washington and quietly working to undermine the departments under their purview. One such is the little-known Administrator of the Centers for Medicare and Medicaid Services (CMMS), Seema Verma.

Founder and former CEO of an Indianapolis-based health-policy consulting firm, Verma was one of Donald Trump’s first appointments, selected to run the CMMS in November 2016. She is a political protégé of Vice President Mike Pence, having served as primary consultant for the design of Indiana’s 2008 Healthy Indiana Plan, a conservative reimagining of the state’s Medicaid program that served as the basis for its Affordable Care Act Medicaid expansion during Pence’s governorship.

The original Healthy Indiana Plan, enacted under Pence’s GOP predecessor Mitch Daniels, mandates that participants contribute to a health savings account (HSA) and pay high deductibles. Failure to maintain such an account means banishment from Medicaid coverage for one year. Verma has called the plan “a strong personal responsibility mechanism;” others have called it punitive.

Under Healthy Indiana Plan 2.0, foolishly granted an ACA waiver by the Obama administration to serve as Indiana’s Medicaid expansion plan (in order to cajole the state into signing up for the added coverage), new beneficiaries are treated as truly second-class citizens. Enrollees are charged monthly premiums (in violation of standard Medicaid practice), required to pay fees for too many emergency room visits, and shut out of coverage entirely for failure to keep up their premium payments. In addition, they must follow complex rules to continue getting full benefits. As visualized by Seema Verma, Medicaid is not an entitlement, but a form of welfare.

Outside Indiana, Verma’s dainty fingerprints are all over similar right-wing Medicaid expansion plans put forth by conservative state administrations that have followed her consulting firm’s guidelines in using Obamacare’s waiver process to distort the ACA’s expanded coverage. Ironically, the waiver clause was originally intended to permit the creation of state single-payer plans in places like Vermont; under Verma, it’s being increasingly used (for example, in Kentucky and Arkansas, as well as Indiana) to allow Medicaid work requirements.

To fully appreciate what’s going on here, it’s necessary to look beyond the mere providing of health care for low-income Americans. Seema Verma and like-minded GOP staffers infiltrating the CMMS under Donald Trump view their true mission as a righteous moral crusade to inculcate conservative social values. On her first day in office, Verma formally urged the nation’s governors to impose insurance premiums on Medicaid, charge recipients for emergency room visits, and pressure those recipients to get jobs.

The stated goal is to convert Medicaid from a form of guaranteed social insurance into a vehicle for ending “government dependence” and demonstrating “the potential for consumer-driven health care as an alternative to the traditional Medicaid model” by encouraging the use of only the health care beneficiaries can personally afford.

There’s also an ulterior motive, now that the federal government is no longer providing a “perverse incentive” by exclusively funding the program’s expansion. That is to save conservative states money by arbitrarily forcing people off Medicaid rolls (through such means as lowering the maximum income qualification and banning “able-bodied adults of working age”); lower enrollments mean, of course, lower state taxes. Arkansas plans to eliminate 60,000 beneficiaries in this manner, thereby fulfilling what Verma calls Medicaid’s “higher purpose.”

But why stop with Medicaid? Seema Verma’s crusade against government-run health care has also targeted Medicare, which (if Republicans retain both houses of Congress in November), will be in the crosshairs come 2019. To start the ball rolling, Verma has trotted out that old, familiar standby: Medicare is unsustainable and will go bust (by 2026 at the latest) unless it’s reformed.

In a Wall Street Journal article late last year, the CMMS administrator announced her agency’s Innovation Center would present ideas to address the program’s imaginary fiscal crisis. These would include giving recipients “incentives to be cost conscious,” interpreted by some as a call to implement Paul Ryan’s long-standing “premium support,” or voucher, proposal.

Premium support (shopping for senior coverage on the open insurance market using an inadequate federal stipend) is part of the plan to create a privatized Medicare system based on profit. Republicans are already part way there in the form of Medicare Advantage, the program George W. Bush introduced that allows federally subsidized private insurers to offer enhanced Medicare for an added premium price.

Notwithstanding its drain on the Treasury, Seema Verma enthusiastically favors Medicare Advantage over traditional Medicare, even though the big insurers managing it (United Healthcare, Humana, et al.) only realize a profit by having her CMMS write off much of their top-heavy administrative overhead, including massive advertising costs and executive salaries.

Nevertheless, corporate welfare in medicine is not a problem in Seema Verma’s world. What does concern her are the insistent and growing calls for a federal single-payer health-insurance system, popularly known as Medicare for All. Verma and her boss, Health and Human Services Secretary Alex Azar, have been in the forefront of those trashing single-payer.

Using the well-worn tactic of scaring seniors, Verma announced in July that expanding the federal health-care role would strain Medicare’s finances and deprive older Americans of their existing coverage. Left unsaid was that it would also derail lucrative privatization schemes and deprive medical insurers of their accustomed monetary windfalls.

Wayne O’Leary is a writer in Orono, Maine, specializing in political economy. He holds a doctorate in American history and is the author of two prizewinning books.

From The Progressive Populist, October 1, 2018

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