In the final days of the Trump administration, as an American was dying every minute of covid-19 and the president’s supporters were taking part in a violent insurrection, Seema Verma joked to various reporters she was looking forward to becoming a “trophy wife.”
For four years Verma has been the head of the Centers for Medicare and Medicaid Services, one of the longest-serving appointees in an administration not particularly known for its job stability. She began her term by sending letters to state leaders recommending they charge people living in poverty insurance premiums and suggesting those who relied on state-supported healthcare needed to prove they had jobs. She’s ending it by telling anyone with a notepad she’s looking forward to taking an indefinite vacation on her husband’s dime. She also insists that she has “no regrets.”
Verma—likely much to her own displeasure—is not a household name. In the pantheon of historically cruel and inept Trump appointees, she’s barely a blip. But her four years of public service are emblematic of the kind of quiet, canny bureaucrat that flourished during this administration, chipping away at public services almost as doggedly as she sought to elevate herself.
In her appointment to run an agency that administers healthcare to the neediest, Verma saw an opportunity to cut services for the poor and wrap it in the language of self-determination, insisting that the personal responsibility which comes with paying health costs out-of-pocket from salaries less than $20,00 would instill pride. Her fetish for the ideals of free-market culminated in a bulky, wasteful mandate requiring hospitals to publish nearly meaningless lists of medical costs, as if Americans in dire need of care would be inclined to compare $90,670 with $68,414 on a website and bargain shop. As she did all this, Verma also appeared to hold a deep-seated conviction that her efforts deserved to be featured in magazines and invited to give speeches: As has been extensively reported, the owner of a $325 moisturizer used millions of dollars in taxpayer funds to unsuccessfully pitch herself as a feminist icon and improve her “personal brand.” Imagine getting a job as a glorified insurance claims administrator for the Trump administration and believing it qualified you to be the woman of the year.
It should be no surprise that Verma ended up as a walking conflict of interest in the Department of Health, as she has done exactly one thing for the bulk of her career. Formerly a liberal-leaning aspiring doctor, Verma appears to have figured out how profitable it can be to help states spend less money on their poor and replicated the process endlessly, first as a private consultant and then as the head of CMS. For over a decade she was the quiet architect of Indiana’s healthcare plans through her own firm—a firm that following the passage of the Affordable Care Act made a tidy business helping other states figure out how to best skirt the mandates of the public option. As a private contractor, she had a massive influence in her state, working out healthcare programs with then-governor Mike Pence from her own office in the government center. In 2014, a journalist discovered she’d been consulting both for the state and one of the companies bidding for a state contract, a minor scandal that would foreshadow her later attitude towards federal disclosure rules.
Once Verma was appointed to head CMS—a position she undoubtedly secured through her work with Pence—she frequently criticized the Affordable Care Act and pushed for the deregulation of CMS. Notably, she championed policies that would require low-income people in many states to enroll in job training programs as a condition of receiving Medicaid coverage. Lawsuits challenging those policies are currently headed to the Supreme Court.
In public statements, Verma favors the euphemisms of a CEO laying off a chunk of their staff, peppering her prepared remarks with references to “rehabilitation” and “independence” and “self-care” when she really means to shrink the narrowing safety net to satisfy her boss. There are hundreds of well-heeled bureaucrats working in the government, and in healthcare more broadly, who are just like Verma: Vain, exacting, and unable to conceptualize their public roles as anything but balances and cells on a spreadsheet. But these are the people who do the work of dismantling agencies and public programs, who figure out how best to get around the legal structures that are supposed to make it hard to yank support away from the low-income and the sick.
Not that Seema Verma cares about any of those people, anyway. They were never going to invite her to give a TED talk or vote her woman of the year.