STAT, October 26, 2017
Casey Ross

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CLEVELAND — With a broad overhaul of Obamacare stalled in Washington, one of President Trump’s top health care leaders is drawing the outlines of sweeping changes to Medicaid that could pare enrollments and cut costs without congressional approval.

Seema Verma, director of the federal Centers for Medicare and Medicaid Services, is promising to give states an “unprecedented level of flexibility” to design their Medicaid programs as they see fit. In an appearance in Cleveland this week, she pledged to reduce scrutiny of state requests for waivers from federal rules meant to preserve access and quality standards.

“We want to get to the point where we are making the whole waiver process easier,” Verma said during a discussion at the Cleveland Clinic’s annual medical innovation summit. “We’re not going to tell the states what their priorities are. They are going to come and tell us what their priorities are.”

Underpinning that effort is Verma’s belief that the expansion of Medicaid under the Affordable Care Act was a disastrous move that extended coverage to millions of low-income people who shouldn’t be getting insurance from the government.

“We’ve put more than 10 million people, 12 million people into this program where the doctors won’t see them, and the policies that are in the Medicaid program are not designed for an able-bodied individual,” she said. Verma added that the administration’s goal is to keep those people in the private insurance market, where they would not be “dependent on public assistance.”

Republicans in Congress have sought to roll back the Medicaid expansion in bills to repeal and replace Obamacare, but those efforts have repeatedly failed.

In response, the Trump administration has vowed to dismantle the Obama-era health plan by executive actions, including halting payments to insurers.

Verma’s tack on Medicaid seems to borrow from a similar philosophy — if legislative changes aren’t forthcoming, then administrative actions are a different means to the same end. [...]

health care finance health care reform health law policy medicaremedicaid public health regulation