Seema Verma, the nominee to head the Centers for Medicare and Medicaid Services, told the Senate Finance Committee on Thursday she is against a voucher program for Medicare, a proposal supported by the man who would be her new boss, Health and Human Services Secretary Tom Price.
"I don't support that," she said to a question from Democratic Sen. Bill Nelson about a Medicare voucher program. "What I do support is giving choices to seniors."
Nelson said Price took a position supporting the voucher system.
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Verma gave few specifics to other questions on how CMS should handle the programs that would come under her administration. It would be up to Congress to make decisions that CMS would then implement, she said.
She declined to answer questions about CMS's proposed changes to the Affordable Care Act released this week intended to help keep insurers in the marketplace.
Verma said she was not involved in that policy, and therefore could not comment.
Ranking Member Ron Wyden said the CMS proposed rule offers consumers less coverage, higher premiums and more out-of-pocket costs for families.
"It's important patients be in charge of healthcare," Verma said.
She also said that she was advised by the Officer of Government Ethics not to answer questions surrounding mental health issues as she is married to a doctor who works in the field.
Verma gave no direct answer as to whether she favored block granting for Medicaid.
She said she would support options to improve outcomes, whether this meant a block grant or per capita cap.
"I'm endorsing the program being changed," she said. "I think we can do better."
On whether she supported women paying more money for maternity care if and when the Affordable Care Act is repealed, Verma said, "I think that women should be able to make the decision that's best for them."
Verma, who was the architect of the Healthy Indiana Plan for Medicaid, and helped other states with waiver programs, voiced support for giving states more of a say.
Medicare Advantage is another way to offer choices to seniors, she said.
"It puts seniors in the driver's seat to figure out what's best for them," she said. "It allows them to make decisions about healthcare and is affordable for them."
Currently, under an inflexible system, states have to go to the federal government and wait years for innovative programs to be implemented.
As to managed care programs, Verma said, "States will spend millions implementing regulations. If confirmed, I would want to take a look at that to make sure we're not burdening the states with that regulation."
To a comment that providers are struggling with regulatory burdens, Verma said she would talk to doctors about how to ease their administrative burden under managed care.
Though she applauds Congress for passing the Medicare Access Chip Reauthorization Act, or MACRA, this can be a challenge for smaller, rural providers, she said.
"I don't know that rural providers want to take on risk at all," she said.
Wyden said it sounded like Verma wanted to keep a fee-for-service program.
"I'm not suggesting that works better," Verma said. "I support efforts to increase coordination of care and hold providers accountable for outcomes. It's another thing altogether to have them accepting risk."
Value-based reimbursement models should be tried in small areas before being expanded, she said, and the results shared with stakeholders.
Patients must also be engaged and have an investment in their health outcomes, she said.
Verma rejected the assertion that some low-income Americans would be left behind.
"Healthy Indiana works for people at the lowest income," she said. "Just because you're poor doesn't mean you're not capable of making a decision. "
The Healthy Indiana Plan has created better outcomes, more primary care visits, better adherence to drug regimens and more satisfaction with care, she said.
As Price often commented during his controversial confirmation hearing last month, Verma, to numerous questions on keeping current levels of coverage for Medicare and Medicaid recipients, said she supported consumer choice and access to affordable care.
At least two Democratic committee members said they hoped Verma would be more direct in answering questions in writing, which Wyden asked Verma to have ready in about three days.
Verma is the founder of SVC Consultants in Indianapolis, Indiana, a national health policy consulting company.