Seema Verma is about to make her mark on Medicaid as Trump's choice to head the Centers for Medicare and Medicaid Services. She's not new to overhauling such a system, which is exactly what she did in Indiana as a consultant who was paid almost $5 million in four years to implement a new program there. Her vision was so positively Republican: Making sure that Medicaid doesn't foster dependency and keep the poor from living up to their "personal responsibility." Alison Kodjak reports:
The plan she came up with for Indiana requires poor Medicaid recipients to make monthly payments for their insurance, or lose benefits.
"Seema was very committed to extending coverage to low-income families in Indiana," says Cindy Mann, who was the CMS official who negotiated the deal with Verma on that state's Medicaid expansion. [...]
Beneficiaries make monthly payments from $1 to about $27 into individual health savings accounts, and the state also contributes. That money can be used for doctor visits and prescriptions.
If beneficiaries get vaccines and other preventive care, they get a discount on their premiums the following year.
But they can also be penalized. People whose incomes are above the poverty line can be cut off for six months if they miss a payment. Those below the poverty line are knocked down to a plan with fewer benefits.
Medicaid eligibility starts at 138 percent of the federal poverty level for a household of one individual—or a yearly income of a little over $16,000**. So presumably, by Verma's standards, anyone making above that who misses a payment is obviously lavishing all their extra income on throwaway items, while anyone making below that is simply undeserving of keeping full benefits because they didn't properly budget their wealth of resources. (**In fact, if their measurement uses the “federal poverty level” and not the Medicaid eligibility line, it’s even lower: $11,880. Either way, it’s an impossibly small amount for anyone to live on.)
"There are many ways to try and effectuate personal responsibility," Mann says. "Some states have moved forward with healthy behavior initiatives, for example. Some states have done some premiums and copays." Indiana's plan requires everyone to contribute to a health savings account. "And so the responsibility was really translated into payment requirements, and with pretty strong consequences if somebody was unable to pay."
She says Verma and Indiana wanted the penalties to be even harsher — a full year with no coverage for people who miss payments. But CMS rejected that idea.
There's nothing quite like someone who's getting paid more than a million dollars per year trying to negotiate ways to punish people who don't even make enough money to put food on the table. NPR goes on to report one example of how great Verma's plan has played out for the impoverished.
Amber Thayer, a mom of three who lives in a Volunteers of America family shelter in Indianapolis, it's been a bit of a nightmare.
Thayer is a recovering addict who has been clean for six months with the help of the medication Suboxone. And she's training to be a nursing assistant.
"It's been quite, quite the struggle, but we've gotten there and we're doing great, and we're getting ready to get into our own home," she says.
She pays $1 a month for her Medicaid insurance.
In October, she got a bill for that $1 from a different company than the one she had been dealing with. She assumed the state had switched her.
"It is only a dollar," she says. "I could pay a dollar a month, or I could pay $12 and that will cover me for the year. Unfortunately, at that time, I only had I believe it was like $2.38 on my card."
So she called the company and used her bank card to pay the dollar.
But the company, or perhaps the state, lost track of her dollar, and her insurance was cut off. She had her bank statement and a receipt from the insurer that proved she had paid. But she still spent six weeks, with multiple phone calls and visits to state health offices, trying to get her coverage restored.
Great. So Thayer took "personal responsibility," the state screwed up and Thayer paid the price, all the while scrounging up enough money to pay for Suboxone out of pocket and worrying that her loss of insurance might preclude her ability to take the nursing assistant exam.
Arkansas reportedly tried something similar but found that the administrative costs weren't worth whatever benefits the program supposedly offered. The state ultimately ditched the program. Here's how the state's former surgeon general, Joe Thompson, felt about the program:
He says the ideas about personal responsibility are politically popular, but implementing them is too complex.
"We lose too many folks along the way, and we may be causing more challenges than we're solving," he says.
Anyway, get ready for someone who has absolutely no idea what it's like to live in poverty to stick it to the poor with a bunch of completely misguided fantasies about how to improve their lives.
"The cost-sharing policy is not to burden the individual," [Verma] told lawmakers at the 2013 hearing. "I think it's to incentivize them and empower them to be part of the equation."