As Donald Trump prepares to move into the White House and Republicans maintain majorities in both the House and the Senate going into 2017, Obamacare is on the chopping block. This we knew already, as Congressional Republicans have tried to repeal key provisions of Obamacare dozens of times, currently have a plan to block a Democratic filibuster in the Senate, and have a Republican president unlikely to veto a repeal bill. As Trump makes his department head picks, the repeal only becomes more likely. What does his choice for head of Centers of Medicare and Medicaid Services, Seema Verma, mean for Medicaid?
Verma, a health policy consultant, worked with Vice President-elect Mike Pence, current governor of Indiana, to design Medicaid expansion in the state. The expansion, which consisted of eligibility criteria that allowed more people to qualify, was a component of Obamacare that many Republican governors like Pence took advantage of in their states — even while Congressional Republicans railed against it. The official GOP platform on health care calls for ending the expansion, replacing it with a block grant or per-capita allotment to states which are then responsible for controlling program costs. People who no longer qualify for Medicaid would, according to the plan, be able to afford insurance by receiving a monthly tax credit.
Though Verma advised Pence and other Republican governors who implemented the voluntary expansion in their states under Obamacare, we shouldn't think that means she'll necessarily fight to keep more people eligible for Medicaid. As Politico reported, part of her advisory work has been encouraging governors to include work requirements in their eligibility criteria, as well as bolstering the role of health savings accounts, two staples of the Republican platform on health care.
Work requirements deny eligibility to people who are deemed able-bodied but can't prove that they are working, actively seeking employment, or undergoing training or education for work. Health savings accounts allow people to put money into accounts for future health care needs without incurring taxes on that income.
We won't have a clear idea of what the GOP plan for Medicaid, and for health care more broadly, will mean for Americans for at least a year, as the repeal legislation will almost certainly involve a transition period. But with Verma in a key position to influence the repeal and replacement of Obamacare, I strongly suspect we can expect Medicaid eligibility criteria to tighten and for greater emphasis to be placed on personal savings than on federal funding, especially since Congressional Republicans back such provisions.