The Senate is slated to vote Monday evening to confirm Seema Verma, President Donald Trump’s choice to head the United States’ two largest government health programs.

Verma is expected to be an influential figure in the GOP effort to wind down the Affordable Care Act’s Medicaid expansion and revamp how state programs receive federal funding.

“She’s committed to protecting Medicare and modernizing Medicaid so the programs deliver the best results for those who need it,” Senate Majority Leader Mitch McConnell (R-Ky.) said Monday in a floor speech. “Remember, Obamacare raided funds from Medicare. Remember, Obamacare dramatically enlarged Medicaid beyond its core focus without improving health outcomes in states like mine.” 

Most Democrats are likely to vote against her confirmation and have highlighted potential conflicts of interest with her work with state Medicaid programs and with private companies involved with Medicaid. She also received Democratic criticism for revealing at her confirmation hearing that she supports making maternity coverage optional.

Verma, who runs the consulting firm SVC Inc., has advised a number of states on conservative Medicaid reforms. Most notably, Verma worked with then-Gov. Mike Pence to implement conservative reforms to expand Indiana’s Medicaid program. Indiana’s expansion program requires enrollees to make monthly payments to savings accounts and includes provisions aimed at keeping able-bodied people from staying on Medicaid long term.

In an opinion piece published in Health Affairs, Verma criticized Medicaid as operating “largely within an antiquated framework that is not designed to prepare members for health coverage after Medicaid, and may even be counterproductive to that end.”

She is also a strong proponent for allowing states to exert greater control over their Medicaid programs, as she did in Indiana by working through the waiver process. Giving states greater control of Medicaid is part of the main GOP proposals to overhaul the ACA.

“Her expertise on Medicaid is going to be very important,” Joseph Antos, a health care policy expert at the conservative American Enterprise Institute, said in a phone interview. “Her understanding of state issues is going to be very important.”

While Verma’s policy positions on Medicaid are well known, her views on Medicare are not as clear, and she has no formal experience working with the program.

“What we don’t know is of course where she stands on Medicare issues,” Antos said.

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