President Donald Trump's nominee (open in new tab) to head the government's major health care program said Thursday that Medicaid needs a complete overhaul, but he does not support turning Medicare into a "voucher" plan.

Indiana health care consultant Seema Verma testified before the Senate Finance Committee as a candidate to lead the Centers for Medicare and Medicaid Services (CMS), a $1 trillion agency that oversees a program covering one in three Americans. [Varma, 46, is a protégé of Vice President Mike Pence, who developed a Medicaid expansion plan along conservative lines when he was governor of Indiana. Her successful consulting business has a staff of about a dozen, and if approved, she would run a government agency with nearly 6,500 employees.

During the hearing, Varma played a cat-and-mouse game with Democratic senators, giving them some hints about her thinking but also deflecting many questions. Senator Ron Wyden of Oregon, the Democratic chairman of the committee, later called the question-and-answer session a "missed opportunity for the candidates."

Republicans praised her performance, but two Republican senators said they were very concerned that revamping Medicaid would leave tens of thousands of uninsured in their states.

Medicaid, a federal program for low-income people, covers more than 70 million Americans, from pregnant women and newborns to elderly nursing home users. Medicaid was expanded by the Obama-era health care law to cover more low-income adults. House Republicans want to cap federal funding, transfer control of Medicaid to the states, and eliminate most of the requirements from Washington.

"The status quo is unacceptable," Verma said of Medicaid. 'We can do a better job ...... We know we are not delivering great health outcomes."

Asked by a senator whether she would support capping the Medicaid program and making it a block grant, she declined to endorse such an approach.

"I support the program being changed to work better for the citizens who depend on it," she said.

The Medicaid expansion system that Burma designed in Indiana uses financial rewards and penalties to direct low-income individuals to front-line primary care providers rather than emergency rooms. Critics say the system confuses recipients and penalizes some through no fault of their own. The proposal she developed for Kentucky includes work requirements for most adults.

In defense of her approach, Verma said that low-income individuals are fully capable of making their own decisions.

Regarding Medicare, which covers the elderly and disabled, Verma said she is "not in favor" of turning it into a voucher plan. This is a term used by critics to describe the proposal that retirees receive a certain payment to purchase coverage from a government-regulated private insurance plan.

Prominent advocates include House Speaker Paul Ryan and newly approved Health Secretary Tom Price. They call this "premium support."

Verma deflected other questions, including whether he would support Medicare negotiating drug prices directly with manufacturers.

At CMS, Verma would also oversee coverage under the 2010 health care law.

Asked by Senator Debbie Stabenow, R-Michigan, whether she supported the law's requirement that insurance plans cover maternity and newborn care, Verma replied that some women want maternity coverage and "some may not choose to do that." The doctors' group said that maternity insurance should be a mandatory benefit because about half of all pregnancies in the U.S. are unplanned.

The Finance Committee vote on Verma's nomination is not expected for at least a week. She is expected to be confirmed by the full Senate.

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