What Medicare & Medicaid Will Look Like Under Verma

On March 13th, the Senate confirmed Seema Verma as head of the Centers For Medicare and Medicaid Services. Verma will have oversight of an agency that handles over $1 trillion a year to pay the medical expenses of low-income and elderly citizens.

A change in leadership is nothing new; the inauguration of a new president brings plenty of change. The question is always about what direction the new leadership will take, with the guidance of the new president, and what that will mean for the average citizen.

For someone approaching Medicare eligibility, what will happen with Verma at the helm? Her background and stated plans, along with the viewpoints of the Trump administration, tell us that we can expect a number of things from her. Consumers approaching their Medicare enrollment period or doing a Medicare eligibility check could find a shift in the requirements as Verma’s plans are enacted.

The first expectation is that there will be a move to increase premiums. Verma’s track record in Indiana suggests an intention to maintain Medicare and Medicaid solvency by modestly increasing premiums for plan members. Verma did so as a part of Vice President Mike Pence’s administration as governor of Indiana, and based on Trump’s determination to cut costs in all aspects of government, we can expect her to do likewise in her federal role. The fairness debate that will inevitably ensue may temper the increases, but as long as the GOP maintains its majority in Congress, some form of premium increase is likely.

There will likely be more support for Verma’s second expected initiative, which is a shift toward more prevention and education activities for health care providers. Verma has stated her desire to improve public health for both financial and ideological purposes; her belief is that the government is better served if it can invest in avoiding common medical conditions rather than spend money trying to correct them. Parts of this philosophy mirror existing efforts put together by Democrats, including the educational components of the SNAP program. We can expect to see Verma work toward nutrition education, cardiovascular health, and cancer prevention, just to name a few.

It is unclear how much of the foundation of Medicare is likely to change under Verma, so there will be considerable question about what options will be available as citizens approach Medicare eligibility age.

The final element of a Verma administration is likely to include an evolution in how plans attempt to steer members toward less costly options. Her Indiana system utilized financial incentives to get consumers to see a primary care physician or other standard practitioner instead of visiting the emergency room for routine illnesses and checkups. It is simple logic; an office visit is considerably less expensive than a visit to the emergency room, and will likely lead to more continuity in care.