WASHINGTON — When the Obamacare insurance exchanges collapse and leave some Americans stranded without health coverage, top Trump administration official Seema Verma says, blame the folks who created them in the first place.
“Right now, if we look at it, this is all because of the Affordable Care Act,” says Verma, the administrator of the Centers for Medicare and Medicaid Services. “I mean, the individual market was working much better than it is now, so this is all the impact of the Affordable Care Act.”
Obamacare expanded health insurance to an estimated 20 million people. But premiums have risen for some Americans, and the exchanges established for those who don’t have employer-provided insurance have been rocked as some companies decide not to participate.
In an interview Tuesday with Capital Download, Verma also criticized Obamacare’s expansion of Medicaid to cover millions of lower-income adults as unwise, saying it “makes a lot of sense” for them to get insurance coverage instead in the private market, in some cases with subsidies. She said she is eager to approve waivers from states that want to experiment with imposing work requirements for able-bodied Medicaid recipients, an idea that the Obama administration had rejected.
“We have reviewed that internally and we think it’s within the authority to be able to approve something like that, within the appropriate safeguards,” she told USA TODAY’s video newsmaker series. “These are very consistent with what’s going on in SNAP (the food-stamp program) and our other welfare programs, and they’ve been very successful.”
Verma was a health care consultant who helped design a controversial Medicaid plan in Indiana for then-governor Mike Pence. Now she is at the center of the nation’s health care debate, overseeing a $1 trillion federal budget and health care programs for more than 100 million Americans. They include Medicaid, the target of more than $600 billion over 10 years in cuts in Trump’s budget proposal released last week.
She is caustic toward Obamacare and unapologetic about a new approach likely to curtail Medicaid coverage for millions. Those affected would include many who voted for candidate Donald Trump, drawn by his promise to disrupt the political system and restore U.S. manufacturing jobs.
What would she say to his supporters worried that they are going to be hurt?
“The plan here is to put these programs in a more sustainable way,” she said. “The president has also introduced a lot of different ideas around creating jobs, around making sure the economy is more secure. So I think the other piece of this program is looking at that, right? We’re hoping that many people won’t be dependent on Medicaid any more because they’re going to have better jobs and they’re going to have health insurance.”
She described Medicaid as an entitlement — that is, a guaranteed benefit — for the elderly, the blind, the disabled, pregnant women and poor children. Medicaid also always offered coverage to some poor adults. They “depend on this very critical safety-net program, and so absolutely, if they did not have the Medicaid program, there would be no other place for them to turn.”
But she distinguished them from those who became eligible for Medicaid under the more generous eligibility rules that were part of the Affordable Care Act’s expansion in 31 states and the District of Columbia. The Kaiser Family Foundation estimates that group at 10.7 million. “I question though whether Medicaid is the best vehicle” for them, she said. “They clearly need some support and they need some assistance, but I think we need to make sure that we can afford those kinds of things.”
A day of reckoning on the nation’s current health care law is approaching, she warned.
“Since I came to the administration, every day we are hearing reports about insurers leaving; we’re hearing about double-digit increases” in premiums, she said, noting that Iowa now has no insurers planning to offer plans in the state exchange designed for those without employer-provided health care. “That’s why I think passage of the bill (to replace the Affordable Care Act) becomes so important.”
Critics say the Trump administration has exacerbated the Affordable Care Act’s problems, including uncertainty over whether payments to insurers to help cover low-income people would continue. And the nonpartisan Congressional Budget Office has calculated that the Republican plan passed by the House of Representatives this month to replace Obamacare would result in 23 million fewer Americans with coverage.
“Really, the House version is something that’s outdated at this point,” Verma responded.
She also disputed the CBO’s record of accuracy as “problematic.” In the works now, she said, is a Senate version that would incorporate Trump’s priorities in a final GOP plan.