On Thursday, February 16, Congressman Mick Mulvaney (R-SC) became the Director of the Office of Management and Budget.  That likely means a stripped down first year budget for the new Administration will be released in March.  That budget will give the first significant and detailed insight into what the new Administration will do on spending increases for Defense and spending cuts for other departments.

Last Thursday was the same day the Senate Finance Committee held its confirmation hearing for Seema Verma to become the Director of the Centers on Medicare and Medicaid Services, CMS. While making opening comments Senator Hatch described Medicaid as a safety-net programs stating,

“The Medicaid program was designed to be a safety net for the most vulnerable Americans. As such, I understand and value the moral and social responsibilities the federal government has in ensuring health care coverage for our most needy citizens.  I am committed to working with states and other stakeholders, and the American public to improve the quality and ensure the longevity of the Medicaid program.”

On the all-important issue of converting Medicaid into a block grant, Senator Dean Heller (R-NV) raised the topic of block grants.  He indicated that he is hearing from hospitals in his home state concerned about block granting Medicaid and asked Ms. Verma about her position but she avoided any specifics stating that she would support, “an approach that improves Medicaid.”  She also avoided commitments on Medicare especially when asked about raising the age of Medicare eligibility from 65 and avoided any commitment on turning Medicare into a voucher.

In his opening comments, Ranking Member, Senator Ron Wyden (D-OR) focused on some of the recent waivers in Indiana that Verma helped to craft. Some of those changes revolved around restrictions on income and work.  He said,

“According to an independent evaluation commissioned by the state of Indiana, more than 2,500 people were bumped from coverage due to a situation like this. I’m also concerned about data from the same report that found more than 20,000 people were pushed onto a more expensive, less comprehensive Medicaid plans because they couldn’t pay or navigate the complicated system Ms. Verma put in place.

He also went on to say:

“Flexibility for states to pursue policies that work well for them is something I’ve always championed. But I’m in favor of flexibility for states when it helps them do better, not when it helps them do worse. I’m proud to say my home state has one of the leading Medicaid programs in the country – and it just got a renewed waiver. States should not be denied the opportunity to do what they want because they don’t pursue policies like Indiana’s”

CMS has a budget over $1 trillion since it oversees Medicare, Medicaid and the CHIP program.  Ms. Verma did not appear to raise some of the ethical issues or questions that Secretary Price encountered so it doesn’t appear her confirmation will run into major roadblocks.