(CHICAGO) The businesswoman President Donald Trump selected to oversee Medicaid has said the program is structurally flawed by policies that burden states and foster dependency.

Seema Verma heads Indianapolis-based SVC Inc., a consulting firm that works with GOP-led states seeking federal leeway in how they spend Medicaid dollars. Her solutions to the flaws she sees in Medicaid can be seen most dramatically in Indiana, where enrollees pay fees and a missed payment means a six-month lockout from the program. A still-pending proposal she developed for Kentucky includes work requirements for most adults.

Democrats in Washington are concerned Verma’s methods may become a favored model as Republicans work to repeal the Affordable Care Act, making it harder for non-disabled adults to get access to health care.

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