[Congressional Record Volume 163, Number 43 (Monday, March 13, 2017)]
[Senate]
[Pages S1764-S1772]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                       Tribute to Dr. Jim Rollins

  Mr. BOOZMAN. Madam President, I rise today to honor Dr. Jim Rollins, 
an Arkansan who has dedicated his life to public education. Dr. Rollins 
is the superintendent of the Springdale, AR, public schools, where he 
has served since 1980.
  Dr. Rollins started his career in the classroom as a science teacher 
in North Little Rock. Since that time, he has consistently sought to 
provide students with a quality education. The work he has done leading 
Springdale's public schools speaks for itself.
  Dr. Rollins' motto when it comes to education is ``Teach them all.'' 
This worthy goal has been especially important in Springdale, where 
enrollment has grown from 5,000 students when Dr. Rollins arrived in 
1980 to nearly 23,000 students today. Many of these students are part 
of immigrant families where English is not their first language. More 
than 55 percent of the district's students are not proficient in 
English, and around 75 percent qualify for free and reduced lunches. As 
you might imagine, this has presented unique challenges to educators in 
Springdale.
  In order to meet these challenges and ensure that the school system 
is doing everything it can to provide these students with a great 
education, Dr. Rollins has introduced innovative programs that cater to 
immigrant families, including the unique Marshallese population in 
Springdale.
  As superintendent, Dr. Rollins has fostered an atmosphere where 
families feel welcome and understood so that parents, students, 
teachers, and administrators are working together to create a 
supportive environment that leads to growth in the classroom. In the 
spirit of engaging the entire family in the education of every child, 
Dr. Rollins has helped lead an effort in Springdale's schools to 
promote English as a second language instruction for students and 
parents.
  This year, Dr. Rollins is once again being recognized for his 
outstanding efforts in the achievements Springdale public schools have 
enjoyed under his leadership. Dr. Rollins is being recognized as one of 
Education Week's 2017 Leaders to Learn From, which highlights forward-
thinking district leaders who are working to enact and inspire change 
in our Nation's public schools. Dr. Rollins is certainly very deserving 
of this honor. You only need to look at the work he has done over 
several decades to understand that he has dedicated his professional 
life to improving public education outcomes for every child in the 
Springdale education district. The teachers and parents in his district 
have also had wonderful things to say about Dr. Rollins and his 
leadership in their community. I am so pleased that his trailblazing 
work in Springdale public schools is being noticed by national 
education organizations.

[[Page S1765]]

  Dr. Rollins has made Arkansas very proud, and we are so grateful for 
his leadership and commitment to educating children no matter where 
they come from or their station in life. I am honored to know Dr. 
Rollins, appreciate his friendship, and look forward to his continued 
stewardship of the public school system in Springdale and the positive 
influence he has on education throughout Arkansas.
  Congratulations, Dr. Rollins, on a job well done.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. WYDEN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WYDEN. Madam President, the hard numbers are now in on TrumpCare, 
and there is no sugarcoating them for the American people, as 24 
million Americans get kicked off their insurance plans, as $880 billion 
is slashed from Medicaid in the first decade, and as a payday worth 
hundreds of billions of dollars goes out to the wealthiest and the 
special interests. That is what is going to be dropped on Ms. Verma's 
plate if she is confirmed and if the bill passes. It is her nomination 
that is up for debate right now, and we should make no mistake that she 
is going to be in charge of the specifics.
  If TrumpCare passes, under section 132, the new Administrator would 
be able to give States a green light to push sick patients into high-
risk pools when the historical record shows that these high-risk pools 
are a failure when it comes to offering good coverage that is 
affordable.
  The new Administrator would be in charge of section 134 and could 
decide exactly how skimpy TrumpCare plans would be and how many more 
Americans would be forced to pay out-of-pocket for the care they need.
  The new Administrator would handle section 135, which paves the way 
for health insurers to make coverage more expensive for those who are 
approaching retirement age. That is just the start.
  The fact is that TrumpCare is about enormous tax breaks for the 
fortunate few, financed by raiding Medicare, gutting Medicaid, and 
hurting older people and the sick and those who are of modest income. 
Ms. Verma would have the job of implementing all of this at the Centers 
for Medicare and Medicaid Services.
  My view is that the Senate cannot debate this nomination without 
debating the matter of the TrumpCare program itself because it will be 
a very huge part of the job. Today, I am going to walk through some of 
the specifics with regard to TrumpCare, beginning with the scheme that 
I call ``Robin Hood in reverse.''
  If you look at the funds, it is clear that this is an eye-popping 
transfer of wealth away from older people, from women and kids--from 
the most vulnerable--directly into the wallets of the fortunate few. No 
part of the TrumpCare bill shows this more clearly than the fact that 
it steals from the Medicare trust fund to pay for a tax cut that goes 
only to the most fortunate--only to those who make a quarter million 
dollars or more per year.
  Everybody in America who brings home a paycheck has a little bit 
taken out each and every time for Medicare. It is right there on the 
pay stub. It is automatic. Under TrumpCare, the only people who are 
going to see a Medicare tax cut are the people who need it the least. I 
want to repeat that. Everybody in America, when one gets a paycheck, 
sees a Medicare tax, and everybody pays it, and we understand why it is 
so important. There are going to be 10,000 people turning 65 every day 
for years and years to come. The only people who are going to get that 
Medicare tax cut are the people who need it the least, and that tax cut 
that is going to go to the fortunate few will take 3 years off of the 
life of the Medicare Program, depleting the program in 2025 instead of 
in 2028.
  That particular cut breaks a clear Trump promise not to harm 
Medicare. All through the campaign, then-Candidate Trump was very, very 
firm in his saying that he would do no harm to Medicare.
  He said:

       You can't get rid of Medicare. Medicare's a program that 
     works . . . I'm going to fix it and make it better, but I'm 
     not going to cut it.

  The promise not to cut Medicare lasted about 6\1/2\ weeks into the 
Trump administration before it was broken. The bottom line is that 
TrumpCare raids Medicare. It raids Medicare and causes harm to Medicare 
in violation of an explicit Trump promise during the campaign, and it 
brings Medicare 3 years closer to a crisis to pay for a tax cut for the 
wealthiest in America.
  So you have this enormous, eye-popping transfer of wealth from 
working people, seniors, and people of modest means to the most 
fortunate. Yet, somehow, people have the chutzpah to say it is a 
healthcare bill? I do not think so. It is a huge, huge tax windfall for 
the fortunate.
  There is also the tax break on investment income. Once again, this is 
a break that is going to only go to the most fortunate among us, and, 
with the investment tax break, the overwhelming majority of the 
benefit--nearly two-thirds of it--will go to the top one-tenth of one 
percent of earners in America. That looks like an awful lot of money 
that is going to be going to the fortunate few, but we are not even 
done there.
  On top of all of this, there is yet another juicy tax--this time for 
health insurance executives' salaries. It is another juicy tax cut for 
executives who are making over $500,000 per year.
  It is not just Medicare that is getting raided under this proposal. 
Some of those who are hit the hardest by TrumpCare are those who are 
approaching retirement age. If you are an older American and are of 
modest income--55 or 60--and you have to get insurance in the private 
market, TrumpCare is going to cause your prices to go through the 
stratosphere. In parts of my home State, especially in rural areas, a 
60-year-old who brings home $30,000 a year could see his insurance 
costs go up by $8,000 or more.
  Much of this is due to what we call an age tax. It is a key part of 
TrumpCare. It is another key part of what Ms. Verma will be in charge 
of implementing. The bill would give health insurance companies the 
green light to charge older people five times as much as they charge 
younger people. If you are a person of modest means, are a few years 
away from qualifying for Medicare, and your insurance premiums jump by 
$8,000, that means you are just out of luck. You are going to be locked 
out of the system. You are, basically, going to have to hope that you 
just do not get sick before you are eligible for Medicare.
  Those tax credits that you hear so much about from TrumpCare 
advocates are not going to be of much consolation to you. That is 
because TrumpCare puts a hard cap on your tax credit as an older 
person--just $4,000--and the odds are good that it would not come close 
to covering the expense of a decent insurance plan.
  Now, I am going to turn to Medicaid because TrumpCare does not just 
make little changes around the margins. It does not strengthen or 
preserve this program that covers 74 million Americans. TrumpCare hits 
Medicaid like a wrecking ball, and it has particular implications for 
seniors. I am going to walk through those.
  The Medicaid nursing home benefit is very much at risk now because of 
the TrumpCare cuts as it relates to Medicaid. Medicaid picks up the 
bill for two out of three nursing home patients. These are the people 
who have worked a lifetime, raised kids, put them through school, and 
scrimped and saved all they could. These are the people who, in Kansas 
and in Oregon and across the country, never went on the special 
vacation, who never bought a boat. All they did was to try to scrimp 
and save and educate their kids. The fact is that growing old in 
America is pricey, and after a few years of balancing the rent bill 
against the food bill and the food bill against the medical costs, what 
happens is that a lot of seniors just exhaust their savings.
  When I was director of the Oregon Gray Panthers, what I saw in my 
State--and it is duplicated everywhere--was older people walking every 
single week on an economic tightrope. They were balancing the food 
bills against the medical bills and the medical bills against the rent 
bills, and they just couldn't keep up. They burn

[[Page S1766]]

through all of their funds and they burn through their modest savings, 
so when it is time to pay for nursing home care, they have to turn to 
Medicaid.
  Today in America, the Medicaid nursing home benefit is a guarantee 
that those vulnerable older people--the people who are walking on that 
economic tightrope--are going to be taken care of. TrumpCare breaks the 
Medicaid nursing home guarantee, and it goes even further than that. A 
lot of States--mine is one--worked hard to give more care choices to 
seniors as well as those with disabilities. Maybe instead of living in 
a nursing home or an institution, they would rather be in the 
community. Maybe they would rather live at home where they are most 
comfortable. TrumpCare could mean that those home- and community-based 
choices could disappear as well.
  So what we are talking about is that with these cuts in Medicaid, at 
a time when, in Kansas and in Oregon and across the country--what we 
have tried to build for older people is a continuum of services. There 
would be help at home. There would be help in terms of long-term care 
facilities. There would be a wide array of choices. And because of 
Medicaid, there was enough money to fund these choices, to fund this 
continuum of care for vulnerable older people. Now, as a result of the 
Medicaid cutbacks, my concern is that there is not going to be enough 
money for any of these choices--not going to be enough money for the 
nursing home benefit, not going to be enough money for home- and 
community-based services. Suffice it to say that my own home State has 
indicated to me that they are very concerned about the cutback in home- 
and community-based services.
  Nobody wants to see older people get nickled and dimed for the basics 
in home care they rely on and good nursing home benefits. Yet, when it 
comes to Medicaid, TrumpCare would effectively end the program as it 
exists today, shredding the healthcare safety net for older people and 
millions of others in our country.
  It puts an expiration date on the Medicaid coverage that millions of 
Americans got through the Affordable Care Act. For many, it was the 
first time they had health insurance. It brought an end to an era where 
those individuals could turn only to emergency rooms for care. And now 
TrumpCare is going to cap the Medicaid budget and just squeeze it and 
squeeze it and squeeze it some more until vulnerable people will not be 
able to get care.
  The program is particularly important for seniors and the disabled, 
and I want to make sure that people understand what it means for 
children as well, for those in the dawn of life as well as those in the 
twilight of life.
  Medicaid pays for half of all births, and kids make up half of 
Medicaid's enrollees. It is important to remember that in many cases, 
these are kids who already have the odds stacked against them. They are 
from low-income families. They are foster kids. They are kids with 
disabilities. We know they are already facing an uphill climb. 
Medicaid, though, has been there now with the Affordable Care Act to 
make sure they could see family practitioners and even pediatric 
specialists. That was just unheard of for these youngsters before the 
Affordable Care Act. And when a kid needs emergency care, Medicaid is 
what makes it affordable. TrumpCare puts that in danger.
  I have talked about what it means for older people and what it means 
for the disabled and what it means for kids, and I am just going to 
keep on going because now that we have the hard numbers in--the hard 
numbers have arrived here in real time from the budget office that is 
charged with giving us this analysis--it is important to talk about 
what it means, because budgets are not just facts and figures and cold 
sheets of paper; they are about people's hopes and aspirations. And the 
hopes and aspirations that I have had since those days when I was 
director of the Oregon Gray Panthers were to make sure that people had 
affordable, quality, decent healthcare choices because in America, if 
you don't have your health, you really are missing much of what makes 
life so special in our country.
  The bill also takes an enormous toll in other areas, and I want to 
mention next opioid abuse. By slashing Medicaid, TrumpCare is going to 
make America's epidemic of prescription drug abuse-related deaths even 
worse.
  The papers this morning had accounts about how families were losing 
most of their children to opioid addiction--most of their children lost 
to opioid addiction--on the front pages of the papers. Medicaid is a 
key source of coverage for mental health and substance abuse disorder 
treatment, particularly after the Affordable Care Act, but this bill 
takes away the coverage for millions who need it.
  Republican State lawmakers, to their credit, have spoken out about 
this issue. Frankly, it just ought to be a head-scratcher for anybody 
who remembers the last Presidential race when, in the primary race, a 
parade of candidates rolled through State after State that had been hit 
hard by the opioid crisis, and all of those candidates were trying to 
outpromise the one who had spoken previously in terms of how they would 
help solve the opioid crisis. Then-Candidate Trump was one of the most 
outspoken on saying that he would fix the opioid crisis. He said he was 
the guy who could end the scourge of drug addiction and get Americans 
the help they need. Instead, what we have is TrumpCare, which makes the 
opioid crisis worse, and there is no getting around it.
  TrumpCare puts States in the unimaginable position of having to 
decide whose Medicaid to slash. Are they going to tell seniors that the 
nursing home benefit is no longer a guarantee and they are going to 
have to get in a long waiting line for an opportunity to get a place in 
the local nursing home? Should they tell pregnant women that births are 
no longer covered? What about telling mothers and fathers that their 
kids are cut off and they will have to hope for the best or make their 
way back to the emergency room?

  I also want to touch on a final point that really deserves some 
discussion and hasn't gotten much, and the finance staff has been 
looking at it; that is, how TrumpCare really creates a disincentive to 
work, because I think TrumpCare and Ms. Verma's role implementing it 
are going to have a substantial effect on American workers and 
entrepreneurs.
  It is my view that TrumpCare creates a substantial, significant 
disincentive to work. Today, if you are on Medicaid, you are able to 
pick up a few extra hours at work or go out and accept a higher paying 
job without the fear that you will lose access to care. That is because 
under the Affordable Care Act, low-income Americans get the most help 
when it comes to paying insurance premiums. A lot of persons can get 
health insurance for less than $100 a month.
  Let's compare that with the TrumpCare approach. Under the TrumpCare 
plan, those who are walking an economic tightrope, bringing home barely 
more than the minimum wage, don't get the most help. They don't get the 
most help, and they could see their insurance costs go up by thousands 
and thousands of dollars each year, which would effectively mean they 
would be locked out of the healthcare system. So for millions of 
persons, staying on Medicaid would suddenly look a lot more attractive. 
Making a little more money and losing your Medicaid coverage could mean 
losing your access to high-quality healthcare altogether. So my view is 
nobody has been able to counter this. TrumpCare, in effect, would keep 
Americans trapped in poverty.
  Entrepreneurs and Americans who want to go back to school to pursue a 
degree would face the same dilemma. Somebody who wants to quit their 
job and pursue their dream of starting their own business ought to be 
able to do it without a fear that they won't be able to any longer 
afford healthcare. The same goes for those who want to go back to 
school full time to pursue a degree or certification. TrumpCare makes 
insurance unaffordable for those persons.
  TrumpCare is going to be the big issue on Ms. Verma's plate if she is 
confirmed this afternoon in the Senate to administer this office. We 
all understand that this bill has been taking a pounding from all 
sides. Moderate Republicans and those who consider themselves 
conservative Republicans are against it. Governors from both

[[Page S1767]]

parties are against it. Democrats are united. The AARP, the American 
Hospital Association, the American Medical Association, and the 
American Nurses Association have all come out against the bill--not any 
surprise to me. I don't think these groups think that healthcare and 
healthcare legislation is primarily about ladling out big tax breaks 
for the fortunate few, but that is what this so-called healthcare bill 
does. And it is financed by raiding Medicare, by gutting Medicaid, and 
by hurting older and sicker and lower income Americans.
  There has been a lot of happy talk about why we ought to support this 
bill, but what I have tried to do this afternoon is lay out the broken 
promises. This weekend, for example, the new Secretary of Health and 
Human Services said: ``I firmly believe that nobody will be worse off 
financially in the process that we're going through, understanding that 
they'll have choices, that they can select the kind of coverage they 
want for themselves and for their family.'' That statement from the 
Secretary of Health and Human Services is disconnected from the facts. 
The simple math shows that TrumpCare forces millions of people--
particularly older people and less affluent people--to pay thousands of 
dollars more for their health insurance.
  The OMB Director, Mick Mulvaney, was pressed on why TrumpCare breaks 
the President's promise of ``insurance for everybody.'' His response 
was that TrumpCare is about access, and the bill ``helps people get 
healthcare instead of just coverage.'' But we all understand that 
access doesn't mean a lot if people can't afford to get coverage. That 
is the future that TrumpCare is going to bring for millions of 
Americans.
  I asked Ms. Verma the most basic questions during her confirmation 
hearing so we could get even a little bit of an insight into how she 
would approach these issues. I asked for one example--these are not 
``gotcha'' questions; these are the questions you ask if you want to 
know about running a program involving $1 trillion. I asked Ms. Verma 
for one example of what to do to bring down the cost of prescription 
medicine. I gave her three or four to choose from. I particularly would 
like to see more transparency by lifting this cloud of darkness 
surrounding how medicines are priced. She didn't have any answers to 
any of these questions.
  So here is where this nomination stands. Ms. Verma gave the Finance 
Committee and the public virtually nothing to go by in terms of how she 
would approach this job, but the fact is that, if confirmed, she would 
be one of the top officials to implement TrumpCare--a bill that raids 
Medicare, slashes Medicaid, and kicks millions of Americans off their 
health plan to pay for a tax cut for the wealthy.
  I am unable to support this nomination, and I urge my colleagues to 
oppose it.
  Mr. President, over the past decade, the Trump administration's 
nominee to be CMS Administrator, Seema Verma, has demonstrated a 
conflicting pattern of working directly for the State of Indiana on its 
health programs while also contracting with a handful of companies that 
provided hundreds of millions of dollars in services and products to 
the very same programs she was helping the state manage.
  Those companies are Hewlett Packard, Health Management Associates, 
Milliman, Inc., Maximus, and Roche Diagnostics. All were vendors to the 
State's Healthy Indiana Program agencies, while Ms. Verma helped design 
and direct that Program--first for Governor Daniels and then for 
Governor Pence. As she describes her role on her company's website, 
``Ms. Verma is the architect the Healthy Indiana Plan (HIP), the 
Nation's first consumer directed Medicaid program under Governor Mitch 
Daniels of Indiana and Governor Pence's HIP 2.0 waiver proposal. Ms. 
Verma has supported Indiana through development of the historic program 
since its inception in 2007, from development of the enabling 
legislation, negotiating the financing plan with the state's hospital 
association, developing the federal waiver, supporting federal 
negotiations and leading the implementation of the program, including 
the operational design.''
  Ms. Verma collected more than $6 million from Indiana taxpayers while 
overseeing the State's Medicaid reform and ACA implementation. At the 
same time, while under contract with the State as a consultant, Ms. 
Verma also collected more than $1.6 million from Milliman Actuaries, 
more than $1 million from Hewlett Packard, $300,000 from Health 
Management Associates, and tens of thousands of dollars from Roche 
Diagnostics and Maximus. All while these companies held important 
contracts with the State.
  In addition to being on ``both sides of the table,'' in at least two 
cases involving her contracts with Hewlett Packard and Health 
Management Associates--her duties for the State of Indiana overlapped 
directly with the tasks those firms were also billing the state to 
complete.
  While there are questions about Ms. Verma's work for the several 
companies above, I want to focus for the moment on what I believe to be 
the clearest conflict: her work on behalf of Hewlett Packard.
  Hewlett Packard Conflicts. In 2014, the Indianapolis Star newspaper 
reported:

       ``Verma's work has included the design of the Healthy 
     Indiana Plan, a consumer-driven insurance program for low-
     income Hoosiers now being touted nationally as an alternative 
     to Obamacare. In all, Verma and her small consulting firm, 
     SVC Inc., have received more than $3.5 million in state 
     contracts. At the same time, Verma has worked for one of the 
     state's largest Medicaid vendors--a division of Silicon 
     Valley tech giant Hewlett-Packard. That company agreed to pay 
     Verma more than $1 million and has landed more than $500 
     million in state contracts during her tenure as Indiana's go-
     to health-care consultant.''

  While this in and of itself is deeply concerning, Indiana state 
contract records show that Ms. Verma was instrumental in helping the 
state determine this contract was even necessary in the first place.
  Let me say that again: Ms. Verma, in her role of advising Indiana, 
helped the state determine there was a need for the services of a 
vendor like Hewlett Packard. She then joined the company on a bid to 
provide those services, received a contract, and was ultimately paid 
more than $1 million. Hewlett Packard bought the company that 
originally contracted with the state, Electronic Data Systems in 2008. 
That company, in a January 2008 press release characterized the Indiana 
contract in this way:

       `` `The EDS solution will provide Indiana with enhanced 
     transparency as it implements Gov. Mitch Daniels' package of 
     Medicaid reforms such as the Healthy Indiana Plan . . .' `At 
     the conclusion of the procurement process, it was evident 
     that EDS was able to bring great value and experience to the 
     taxpayers of Indiana,' said Mitch Roob, Family and Social 
     Services Administration Secretary. `The technology and 
     insight that EDS has to offer will be a tremendous asset as 
     we continue to make great strides in new, innovative 
     programs, such as the Healthy Indiana Plan.' ''

  Ms. Verma helped Indiana outline Medicaid reform policy goals as 
State contractor before joining a vendor in its bid to fulfill those 
duties--and then remained a paid participant on both sides. 
Furthermore, it appears that Ms. Verma was billing Hewlett Packard and 
Indiana, in some cases, for the same work she was already performing 
under her own contracts with the State. In written responses for the 
record to the Finance Committee, Ms. Verma provided a 2013 presentation 
from Hewlett Packard and herself to Indiana health program executives.
  The presentation identified several functions that Ms. Verma would 
provide to the State through the Hewlett Packard contract. Many of 
those duties are exceptionally similar to duties the State had already 
contracted with her directly to provide in 2012 and 2013.
  For example, that 2013 presentation outlined specific duties HP was 
paying her to perform that included: monitoring the Federal regulatory 
environment, providing Medicaid policy expertise, and supporting 
Indiana's State Plan Amendment waivers and process. These were things 
Verma was already under contract to provide the state directly.
  On February 21, 2012, Verma's firm was contracted by the State to 
review Federal regulations that would impact Indiana's Healthy Indiana 
Plan.
  On May 13, 2013, she was contracted to provide the State with advice 
on the impact of new ACA regulations related to Medicaid.
  To me, that sounds a lot like monitoring the federal regulatory 
environment in the HP presentation.

[[Page S1768]]

  Under the February 21, 2012 contract, Verma's firm was contracted by 
the State to provide general policy expertise to the Healthy Indiana 
Program--also known as Indiana's Medicaid program.
  To me, that sounds a lot like providing Medicaid policy expertise in 
the HP presentation.
  Under this same February 21, 2012 contract, Verma's firm was 
contracted by the State to develop State Plan Amendments and waivers--
these are the agreement between the State and Federal Governments that 
ensures the State adheres to Federal rules for Medicaid and CHIP.
  To me, that sounds a lot like supporting Indiana's State Plan 
Amendment waivers and process in the HP presentation.
  Ms. Verma has not addressed how being paid twice for what appears to 
be largely similar work was ethical. She has, however, consistently 
denied that any conflicts of interest existed while she worked both 
sides of these deals in Indiana. During her confirmation hearing before 
the Senate Finance Committee on February 16, 2017, Ms. Verma claimed 
she had her staff recused themselves when potential conflicts arose:

       ``When there was the potential or when we were working on 
     programs, we would recuse ourselves. So we were never in a 
     position where we were negotiating on behalf of HP or any 
     other contractor with the state that we had a relationship 
     with.''

  That all sounds well and good but that claim has been disputed by the 
former head of Indiana's Family and Social Services Agency. As first 
reported in 2014 by the Indianapolis Star,

       ``Verma's arrangement with HP also came as a surprise to 
     former FSSA Secretary Debra Minott, who said she learned 
     about it sometime in 2013. `We had delayed paying an HP 
     invoice because of an issue we were trying to resolve, and HP 
     sent Seema to our CFO to resolve the issue on their behalf,' 
     Minott said. `I was troubled because I thought Seema was our 
     consultant.' ''

  Ms. Minott made this allegation again just last month in a February 
14, 2017 story by the Associated Press about Ms. Verma's conflicts,

       ``There was at least one instance where Verma crossed the 
     line in Indiana when she was dispatched by HP to help smooth 
     over a billing dispute, said Minot. `It was never clear to me 
     until that moment that she, in essence, was representing both 
     the agency and one of our very key contractors,' said Minot, 
     who was removed as head of the agency by Pence over her 
     disagreements with Verma. `It was just shocking to me that 
     she could play both sides.' ''

  Additionally, in response to questions for the record that I 
submitted to Ms. Verma, she said that her firm worked directly with HP 
for the state, and that representatives from SVC participated in 
meetings between the state and HP,

       ``SVC worked with the State of Indiana and its vendors, 
     including HP, to design systems for implementation of the 
     Healthy Indiana Plan. We helped vendors translate the policy 
     and waiver language into system operations. We did not 
     oversee HP or any other vendor in this regard, and did not 
     negotiate or participate in change orders or contract 
     amendments. To the best of my recollection, State officials 
     participated in all meetings with HP regarding the Healthy 
     Indiana Plan work at which SVC representatives were also 
     present.''

  That sounds to me like Ms. Verma and her team were in meetings with 
both HP and the State discussing issues where her duties clearly 
overlapped and when she was being paid by both parties. In fact it 
sounds like the only safeguard in place was that State officials sat in 
on these meetings between her firm and HP.
  Finally, with regard to her claim that she always recused herself, I 
specifically asked her to provide for the record any documentation that 
she had of the process for determining when she needed to recuse 
herself and documentation of the recusals actually taking place. She 
replied that there were none.
  Consequently, it's hard to believe Ms. Verma was truly able to avoid 
very real conflicts of interest while she and/or her firm were guiding 
HP's work on behalf of the State and sitting in on meetings with both 
the state and HP while being paid by both.
  In the case of Health Management Associates, Verma also had contracts 
with the state that covered the exact same work HMA was separately 
being paid by Indiana to fulfill and while she was also being paid by 
HMA. For example, in 2007, the State awarded Verma's firm a non-
competitive contract to develop the Request for Proposal for a company 
to implement the Governor's Healthy Indiana Program. On the same day, 
Indiana gave HMA its own non-competitive contract to develop the very 
same proposal. This occurred while HMA was also paying Verma's firm on 
a separate but related contract. Again, as in the case of HP, she was 
helping the State manage key programs while being paid by contractors 
performing work for those programs. In this case, what she was doing 
for the State was essentially the same thing that the contractor was 
being paid to do--develop a Request for Proposal to implement the 
Healthy Indiana Plan.
  Ms. Verma claims there was no conflict because she did not directly 
oversee these two contractors--HP and HMA--in her role with State. She 
also points to the fact that in 2012 she received an opinion from the 
Indiana Ethics Commission that stated her work for HP was not in 
violation of state conflict of interest laws because she was a 
consultant, not a State employee.
  I do not believe that her work for the State and her work for these 
contractors was a true arms-length relationship. As the Associated 
Press recently highlighted, Ms. Verma maintained an office in the State 
government center and that the AP characterized her work as ``usually 
reserved for state administrators.'' The existence of this opinion, in 
my view, does not absolve Ms. Verma from what look to be very clear and 
obvious conflicts of interest.
  I am not alone in this opinion, as President George W. Bush's ethics 
lawyer Richard Painter--hardly a liberal partisan--said Ms. Verma's 
consulting arrangement in Indiana, ``clearly should not happen and is 
definitely improper.'' Ms. Verma helped the State decide it needed a 
vendor like HP, and then went to work for HP on the resulting contract. 
She was also under contract with yet a third company--Health Management 
Associates--which was being paid to develop the Request for Proposal 
for the same contract. That certainly seems like a conflict of interest 
to me.
  When I asked her in writing whether she had obtained similar ethics 
opinions with regard to her work for any of the other state contractors 
who had hired her--Milliman, Roche Diagnostics, Maximus, or Health 
Management Associates, she said she hadn't.
  All of these companies continue to do business with the State of 
Indiana and with other State and Federal health programs that will be 
under Ms. Verma's purview at CMS. Maximus, for example, is the largest 
provider of enrollment services for these programs in the U.S.
  Just because Indiana chose to play fast and loose with conflicts of 
interest doesn't mean that these practices were right.
  I have no confidence that Ms. Verma will take her responsibilities to 
avoid such conflicts at CMS any more seriously than she did in Indiana.
  Mr. President, I ask unanimous consent to have the following 
documents printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                     [from INDYSTAR, Nov. 29, 2016]

 Seema Verma, Powerful State Health-Care Consultant, Serves Two Bosses

                             (By Tony Cook)

       President-elect Donald Trump has tapped Seema Verma, a 
     consultant who helped craft the state's Healthy Indiana Plan, 
     to serve as head of the Centers for Medicare and Medicaid 
     Services. Verma worked closely to shape the health care 
     policy of both former Gov. Mitch Daniels and Gov. Mike Pence.
       The health policy consulting company she heads, SVC Inc., 
     also has provided its services to Iowa, Ohio, Kentucky, 
     Tennessee and Michigan. A 2016 recipient of the Sagamore of 
     the Wabash award, Verma also served as vice president of 
     planning for the Health and Hospital Corporation of Marion 
     County. She also holds a master's of public health from Johns 
     Hopkins University.
       Meet the architect of Gov. Mike Pence's signature health-
     care plan, Seema Verma.
       For more than a decade, the little-known private consultant 
     has quietly shaped much of Indiana's public health-care 
     policy. The state has paid her millions of dollars for her 
     work--amid a potential conflict of interest that ethics 
     experts say should concern taxpayers.
       Largely invisible to the public, Verma's work has included 
     the design of the Healthy Indiana Plan, a consumer-driven 
     insurance program for low-income Hoosiers now being

[[Page S1769]]

     touted nationally as an alternative to Obamacare. In all, 
     Verma and her small consulting firm, SVC Inc., have received 
     more than $3.5 million in state contracts.
       At the same time, Verma has worked for one of the state's 
     largest Medicaid vendors--a division of Silicon Valley tech 
     giant Hewlett-Packard. That company agreed to pay Verma more 
     than $1 million and has landed more than $500 million in 
     state contracts during her tenure as Indiana's go-to health-
     care consultant, according to documents obtained by The 
     Indianapolis Star.
       Verma's dual roles raise an important question: Who is she 
     working for when she advises the state on how to spend 
     billions of dollars in Medicaid funds--Hoosier taxpayers or 
     one of the state's largest contractors?
       In a written statement, Verma said unequivocally that she 
     played no role in HP's contracts with the state. ``SVC has 
     disclosed to both HP and the state the relationship with the 
     other to be transparent,'' Verma said. ``If any issue between 
     HP and the state presented a conflict between the two, I 
     recused myself from the process.''
       But the recently ousted head of the state agency 
     administering Verma's contract told The Star that Verma once 
     attempted to negotiate with state officials on behalf of 
     Hewlett-Packard, while also being paid by the state.
       HP said it can find no one in its company with any 
     recollection of such a meeting. Verma declined to answer 
     further questions about her work with the state or HP.
       Verma's dual roles have surprised some leading Republican 
     lawmakers and expose one of many loopholes in Indiana's 
     government ethics laws.
       Ethics experts consulted by The Star called the arrangement 
     a conflict of interest that potentially puts Indiana 
     taxpayers at risk. If Verma were working for the federal 
     government, they point out, she would have to show how the 
     government was protected, or step aside.
       ``If I were a taxpayer in Indiana, I would be concerned 
     about whether the advice the government was receiving from 
     her was tainted by her own financial interest and the 
     financial interest of her other clients,'' said Kathleen 
     Clark, a professor at Washington University School of Law in 
     St. Louis who specializes in government ethics.
       But in Indiana, government consultants aren't required to 
     disclose such potential conflicts, even when they have 
     offices in state government, as Verma does.
       So the nature of Verma's work--and the extent to which it 
     benefited HP--remains unclear.
       HP referred any other questions on the matter to the state. 
     Verma's spokesman, Lou Gerig, noted in a statement that ``all 
     contracts between the state and SVC Inc., or between the 
     state and SVC Inc. as a subcontractor, have been reviewed and 
     approved in accordance with all requirements of state law.''
       Pence's office issued a written statement in response to 
     The Star's questions.
       ``Seema has played a valuable role in the state's health-
     care policy since the O'Bannon administration, and we 
     appreciate her advice and counsel, especially on the 
     continuation of the Healthy Indiana Plan and HIP 2.0,'' said 
     Christy Denault, a spokeswoman for Pence.
       State officials didn't directly address questions about 
     Verma's work for HP. But James Gavin, spokesman for the 
     Indiana Family and Social Services Administration, said the 
     state does take steps to prevent conflicts in the bidding 
     process.
       He said the state's procurement guidelines ``clearly 
     require that all decision-making authority lie with state 
     employees and agency executives. These guidelines are 
     designed to eliminate conflicts of interest.''


                          Powerful contractor

       Verma enjoys a tremendous amount of sway for a private 
     contractor. She has her own office at the state government 
     center. Earlier this year, Pence turned to her to broker a 
     deal with the state's hospital industry to help finance his 
     plan to expand the Healthy Indiana Plan. And when Verma and 
     one of Pence's Cabinet members--Family and Social Services 
     Administration Secretary Debra Minott--butted heads over how 
     soon to roll out the program, it was Minott who lost her job.
       Verma's influence reaches back at least a decade and across 
     the administrations of four governors, two from each party. 
     During his first term, Gov. Mitch Daniels tapped Verma to 
     help create a new health-care plan to address the state's 
     uninsured population. Her solution: the Healthy Indiana Plan, 
     a new low-income health insurance program that features high 
     deductibles and requires participants to contribute a portion 
     of their income to a health savings account.
       ``This structure melds two themes of American society that 
     typically collide in our health-care system, rugged 
     individualism and the Judeo-Christian ethic,'' Verma wrote in 
     a 2008 Health Affairs blog article co-authored with former 
     FSSA Secretary Mitch Roob. ``HIP combines these diametrically 
     opposed themes by promoting personal responsibility while 
     providing subsidized health protection to those who can least 
     afford it.''
       The plan won the support of both Republicans and Democrats 
     in the Indiana legislature and was implemented in January 
     2008. Today, 52,000 Hoosiers are enrolled in the program.
       Now, Pence wants to expand the plan to an additional 
     350,000 low-income Hoosiers through what he's calling HIP 
     2.0. And like Daniels, he turned to Verma for help in 
     developing the plan and negotiating a financing agreement 
     with the state's hospital industry. If approved by the 
     federal government, billions of new Medicaid funds would flow 
     to the state.
       And because HIP 2.0 would generate significantly more 
     claims, some of that money would likely go to Hewlett-
     Packard, Verma's other client.
       The extent to which Verma's advice has benefited HP is 
     difficult to determine, given that none of the parties 
     involved will talk much about the subject. Further obscuring 
     the issue: Several of her most recent contracts weren't 
     publicly available on the state's online transparency portal 
     until The Star began making inquiries. Denault said that was 
     because ``some of them were mistakenly coded as not for 
     publication.'' The contracts have since been added to the 
     online list.
       What they show is that her duties involve crafting 
     requirements for contractors. negotiating with contractors 
     and supervising vendors. Her company's website also says she 
     provided ``requirements for the state's three technology 
     vendors to support HIP.'' That would include Hewlett-Packard. 
     One contract gives her the authority to ``initiate and/or 
     track'' a contract or contract amendments with the state's 
     fiscal intermediary, which is HP. Another puts her in charge 
     of technical changes to the state's medical management 
     information system, which is operated by HP.
       Those responsibilities put Verma in the position of making 
     decisions about a state contractor that is also paying her 
     hundreds of thousands of dollars. HP's claims management and 
     information system contracts show it has agreed since 2007 to 
     pay Verma's company $1.2 million as a subcontractor for 
     ``health consulting services.''
       During that time, HP received more than $500 million in 
     state contracts, including millions of dollars in contract 
     changes to accommodate the Healthy Indiana Plan that Verma 
     helped create and other new programs.
       ``Certainly on the face of it, there is the appearance of a 
     conflict,'' said Trevor Brown, an expert on government 
     purchasing and director of Ohio State University's John Glenn 
     School of Public Affairs.
       If Verma was a federal contractor, her dual roles ``would 
     certainly raise tremendous concern for regulators and 
     purchasing officials,'' he said. ``This is exactly the kind 
     of thing that would land an agency in a hearing before a 
     legislative oversight committee.''
       Lawmakers in Indiana, however, were unaware of Verma's work 
     for HP.
       ``I was only aware she was working for the state,'' said 
     Sen. Patricia Miller, R-Indianapolis, chairwoman of the 
     Senate Health Committee.
       ``There certainly appears to be the potential for conflict, 
     and appearances matter,'' said Ed Clere, R-New Albany, 
     chairman of the House Health Committee.
       Verma's arrangement with HP also came as a surprise to 
     former FSSA Secretary Debra Minott, who said she learned 
     about it sometime in 2013.
       ``We had delayed paying an HP invoice because of an issue 
     we were trying to resolve, and HP sent Seema to our CFO to 
     resolve the issue on their behalf,'' Minott said. ``I was 
     troubled because I thought Seema was our consultant.''
       HP spokesman Bill Ritz said the company ``checked with a 
     number of its employees and can find no one with any 
     recollection of such a meeting.''
       Gerig, Verma's spokesman, said Verma's work for HP was a 
     matter of public record because she is listed as a 
     subcontractor in HP's contracts with the state.


                            A lack of rules

       Ethics experts say that kind of scenario would be unlikely 
     at the federal level, where government purchasing officers 
     are required to identify and avoid ``organizational conflicts 
     of interest,'' which occur when a person is unable or 
     potentially unable to render impartial assistance or advice 
     to the government because of other business relationships.
       Many states, including Maryland, Virginia, Minnesota and 
     Illinois, have adopted similar rules at the state level, 
     according to Dan Forman, a Washington, D.C.-based government 
     procurement attorney. Other states, such as Tennessee and 
     Washington, have implemented rules at the agency level. Still 
     others, such as California and Maine, have introduced rules 
     via standard state contract provisions.
       But in Indiana, that's not the case.
       Minott said when she brought her concerns to FSSA's ethics 
     officer, she was told Indiana's ethics rules didn't apply to 
     conflicts of interests among state contractors.
       The lack of any such rule is just the latest in a litany of 
     loopholes that good government advocates say Indiana needs to 
     address.
       In recent months, The Star has reported on several high-
     profile cases--including those of state Rep. Eric Turner, 
     former highway official Troy Woodruff and former state 
     schools chief Tony Bennett--where ethics officials criticized 
     the behavior of public officials but took little or no action 
     due to exemptions in state ethics rules.
       The issues raised in Verma's case are not unique to 
     Indiana, said Brown, the Ohio State professor. State 
     governments across the country are increasingly grappling 
     with potential conflicts of interest as more private 
     contractors perform what has traditionally been government 
     work.

[[Page S1770]]

       ``Historically, the practice was these decisions would be 
     made by the leadership of the agency, and in many states they 
     are,'' he said. ``But Indiana is not alone in having to rely 
     on advice and services of a private actor to perform what is 
     at the boundary of, if not a clear instance of, a government 
     function.''
       State reliance on private contractors is especially common 
     in the health-care arena, where rapid changes in federal 
     health-care law have put a premium on speed. And indeed, 
     several executive summaries of Verma's contracts emphasize 
     the need to quickly utilize her services amid the threat of 
     losing federal grant money.
       ``Over the short run, it sounds like you're going to get 
     speed,'' Brown said. ``And you may get some cost savings over 
     the short run.''
       But in the long run, states can become dependent on private 
     contractors, who can then jack up their prices.
       ``They essentially become a monopoly, and there's a risk 
     that they can raise costs over time,'' he said. Verma's 
     arrangement with the state demonstrates how difficult it can 
     be to control such costs.
       An amendment to her contract in January added $300,000 
     without increasing her workload or extending the term of the 
     contract. The reason listed: ``to cover claims.'' State 
     officials declined to elaborate.
       The hourly rates listed in her contracts also have 
     increased over time, from $110 in 2007 to $135-$165 this 
     year.
       Lawmakers expressed surprise when told by The Star that the 
     state paid Verma's company $1.15 million in the past year 
     alone.
       ``I had no idea her firm received that much money. I think 
     it would come as a surprise to most legislators,'' Clere 
     said. ``I think there's a larger issue of transparency and 
     accountability as the state increasingly relies on 
     contractors, including consultants. I'm all for harnessing 
     the power of the private sector, and the key word is 
     `harness,' which suggests the state is in control. The 
     question here is, `Whose hands are on the reins?' ``
                                  ____


               [From the Associated Press, Feb. 15, 2017]

      Pick for Medicare Post Faces Questions on Indiana Contracts

                (By Brian Slodysko and Carla K. Johnson)

       Indianapolis.--President Donald Trump's pick to oversee 
     Medicare and Medicaid advised Vice President Mike Pence on 
     health care issues while he was Indiana's governor, a post 
     she maintained amid a web of business arrangements--including 
     one that ethics experts say conflicted with her public 
     duties.
       A review by The Associated Press found Seema Verma and her 
     small Indianapolis-based firm made millions through 
     consulting agreements with at least nine states while also 
     working under contract for Hewlett Packard. The company holds 
     a financial stake in the health care policies Verma's 
     consulting work helped shape in Indiana and elsewhere.
       Her firm, SVC Inc., collected more than $6.6 million in 
     consulting fees from the state of Indiana since 2011, records 
     show. At the same time, records indicate she also received 
     more than $1 million through a contract with Hewlett, the 
     nation's largest operator of state Medicaid claims processing 
     systems.
       Last year, her firm collected an additional $316,000 for 
     work done for the state of Kentucky as a subcontractor for HP 
     Enterprises, according to documents obtained by AP through 
     public records requests.
       In financial disclosures posted this week, Verma reported 
     she has an agreement to sell SVC Inc. to Health Management 
     Associates of Lansing, Michigan, within 90 days of her 
     confirmation.
       In a statement, a spokesman for Verma said there was no 
     conflict of interest and added that she has the support of 
     former officials who served with her under Pence.
       Her firm was ``completely transparent in regards to its 
     relationship with HP and that there was never a conflict of 
     interest,'' spokesman Marcus Barlow said in a statement.
       A spokesman for Pence did not respond to a request for 
     comment.
       Verma faces a Senate Finance Committee hearing on Thursday. 
     Democrats in Washington are aware of many of her consulting 
     arrangements, and have broader concerns about her philosophy 
     about government entitlement programs, lack of background in 
     Medicare and inexperience leading a large organization.
       As a trusted adviser to Pence, she had an office in the 
     state government center and took on duties usually reserved 
     for state administrators. Verma was also widely respected for 
     her grasp on policy and designed a federal Medicaid waiver 
     that allowed Pence to undertake his own conservative 
     expansion of the program while still accepting money made 
     available through the Affordable Care Act.
       Verma did not specifically address how she would handle 
     decisions related to HP in a letter to the Department of 
     Health and Human Services that was released this week. The 
     letter outlined her plan for managing potential conflicts of 
     interest should she be confirmed by the Senate to lead the 
     Centers for Medicare & Medicaid Services. Her relationship 
     with HP was first reported by the Indianapolis Star in 2014.
       Legal and ethics experts contacted by AP say Verma's work 
     for Hewlett, and offshoot HP Enterprises, raised questions 
     about where her loyalties lay--to the company, or to state 
     taxpayers.
       Richard Painter, former President George W. Bush's chief 
     ethics lawyer, called Verma's arrangement a ``conflict of 
     interest'' that ``clearly should not happen and is definitely 
     improper.''
       Such arrangements are typically prohibited for rank-and-
     file state employees under Indiana's ethics rules and laws, 
     but they're murkier when it comes to consulting work. 
     Contractors have often replaced state employees in a GOP bid 
     to drive down the number of public employees, distinctions 
     between the two can be hard to discern.
       ``She was cloaked with so much responsibility and so much 
     authority, people thought she was a state employee,'' said 
     Debra Minot, a former head of Indiana's Family and Social 
     Services Agency under Pence who worked with Verma.
       Indiana University law professor David Orentlicher compared 
     Verma's dual employment to an attorney who represents both 
     the plaintiff and the defense in a lawsuit. It's also similar 
     to federal contract negotiator with a side job for a company 
     they regularly negotiate with, he said.
       ``If you have one person on both sides of the negotiating, 
     they can't negotiate hard for both sides,'' said Orentlicher, 
     a former Indiana Democratic state lawmaker.
       There was at least one instance where Verma crossed the 
     line in Indiana when she was dispatched by HP to help smooth 
     over a billing dispute, said Minot.
       ``It was never clear to me until that moment that she, in 
     essence, was representing both the agency and one of our very 
     key contractors,'' said Minot, who was removed as head of the 
     agency by Pence over her disagreements with Verma. ``It was 
     just shocking to me that she could play both sides.''
       State contracts show Verma's duties to Indiana and Hewlett 
     have overlapped at times. One agreement she held with the 
     state's social services agency required her to ``provide 
     technical assistance'' to state contractors, as well as the 
     governor's office. Another duty was ``contract development 
     and negotiation'' with vendors, which included HP and HP 
     Enterprises
       Verma reported her salary with SVC is $480,000 and her 
     business income from the company as nearly $2.2 million.
                                  ____


        [From Electronic Data Systems Corporation, Jan. 7, 2008]

         Indiana Awards EDS New $209 Million Medicaid Contract


       Agreement Extends 16-Year Relationship with Hoosier State

       Indianapolis.--EDS, Indiana's Medicaid partner since 1991, 
     has been awarded a $209.9 million, six-and-a-half-year 
     contract to upgrade and continue to maintain the state's 
     Medicaid Management Information System.
       The new contract will leverage EDS' leading-edge 
     interchange Health System, which serves as an industry model 
     and is in operation or being implemented in more than a dozen 
     states, including Kansas, Oklahoma, Pennsylvania and 
     Kentucky. Among the upgrades are a Web-based tool that will 
     enable health care providers to electronically enroll in the 
     Medicaid program as well as a number of internal processes.
       EDS will continue as fiscal agent to the state and its 
     27,000 health care providers, who care for more than 800,000 
     recipients and comprise the nation's 17th-largest Medicaid 
     program.
       The agreement includes a seven-month phase to design, 
     develop, test and implement the additional features followed 
     by a six-year management term.
       The contract, which was signed in late December, extends a 
     16-year relationship between EDS and Indiana.
       The EDS solution will provide Indiana with enhanced 
     transparency as it implements Gov. Mitch Daniels package of 
     Medicaid reforms such as the Healthy Indiana Plan, which 
     provides health coverage to previously uninsured Indiana 
     residents, and the movement of aged, blind and disabled 
     residents to a care management model. It also will continue 
     claims processing coverage for other Indiana health programs.
       ``At the conclusion of the procurement process, it was 
     evident that EDS was able to bring great value and experience 
     to the taxpayers of Indiana,'' said Mitch Roob, Family and 
     Social Services Administration Secretary. ``The technology 
     and insight that EDS has to offer will be a tremendous asset 
     as we continue to make great strides in new, innovative 
     programs, such as the Healthy Indiana Plan.''
       ``As Indiana's technology partner for more than a decade 
     and a half, EDS understands the Healthy Indiana Plan and the 
     state's goal to cover its uninsured residents,'' said Sean 
     Kenny, vice president, EDS Global Health Care. ``Our 
     continued relationship will provide stability not only for 
     the current Medicaid program, but also for future reforms.''
       ``Long relationships are reflections of earned trust and 
     understanding of cultures and goals,'' said Barbara Anderson, 
     vice president, EDS U.S. Government Health Care. ``Over the 
     years, Indiana and EDS together have delivered program 
     efficiencies to enable reforms and help push forward vital, 
     new programs to improve health outcomes for Hoosiers.''
       EDS is the nation's largest provider of Medicaid and 
     Medicare process management services, administering more than 
     $100 billion in benefits a year. EDS processes about 1 
     billion Medicaid claims annually, more than any other 
     company, and provides fiscal

[[Page S1771]]

     agent services/Medicaid information technology support for 21 
     states. Through its global healthcare services and solutions, 
     EDS touches more than 200 million patient lives each day.


                               About EDS

       EDS (NYSE: EDS) is a leading global technology services 
     company delivering business solutions to its clients. EDS 
     founded the information technology outsourcing industry 45 
     years ago. Today, EDS delivers a broad portfolio of 
     information technology and business process outsourcing 
     services to clients in the manufacturing, financial services, 
     healthcare, communications, energy, transportation, and 
     consumer and retail industries and to governments around the 
     world. Learn more at eds.com.
       The statements in this news release that are not historical 
     statements, including statements regarding the amount of new 
     contract values, are forward-looking statements within the 
     meaning of the federal securities laws. These statements are 
     subject to numerous risks and uncertainties, many of which 
     are beyond EDS' control, which could cause actual results to 
     differ materially from such statements. For information 
     concerning these risks and uncertainties, see EDS' most 
     recent Form 10-R. EDS disclaims any intention or obligation 
     to update or revise any forward-looking statements, whether 
     as a result of new information, future events or otherwise.
                                  ____


       [From Hewlett-Packard Development Company, Nov. 21, 2013]

                          FSSA Executive Tour

                           (By John Wanchick)


                               Presenters

       John Wanchick, Account Executive; Scott Mack, HPES Regional 
     Manager, State Health and Human Services; Jason Schenk, HPES 
     Sales; Heather Lee, Claims Director; Doug Weinberg, CFO and 
     Third Party Liability Director; Sandra Lowe, Provider and 
     Member Services Director; Rebecca Siewert, Managed Care 
     Director; Beth Steele, Long Term Care Director; Lisa Pierce, 
     Audit and Compliance Director; Maureen Hoffmeyer, 
     Publications Director; Patrick Hogan, System Director; Darren 
     Overfelt, ITO Director; Bev Goodgame, PMO and Business 
     Analysis Director; Julie Sloma, DDI Project Manager; Pat 
     Steele, Operations Manager; Seema Verma, Executive Healthcare 
     Policy Consultant.


                  Indiana Core MMIS HP-SVC Partnership

       Provides innovative services to support Medicaid Policy; 
     External Scan: Monitoring federal regulatory environment, 
     Financial, demographic, utilization, public health data, Best 
     practices; Support Goal & Objective Setting Process; Develop 
     and Maintain Program Policy; State Plan Maintenance: Support 
     with State plan and waivers.
                                  ____

                                                   March 30, 2012.
     Ethics Opinion
       Dear Ms. Verma: Thank you for contacting our office. I 
     understand you are requesting ethics advice to determine 
     whether a conflict of interest would arise under the Indiana 
     Code of Ethics set forth in 41 I.A.C. 1-5 (``Code of 
     Ethics'') if SVC, Inc. d/b/a Seema Verma Consulting (``SVC'') 
     entered into a consulting agreement with Hewlett-Packard 
     Company (``HP'') to assist HP on a contract HP has and/or 
     would have with the Indiana Family and Social Services 
     Administration (``FSSA''). In your inquiry, you explain that 
     SVC is an Indiana Corporation that provides a range of 
     consulting services on health policy, including policy and 
     legislative analysis, grant and proposal development, project 
     and grants management, managing community and stakeholder 
     relationships, survey and evaluation design and data 
     analysis. You further explain that SVC is currently a 
     contractor to the State of Indiana (``State''), specifically 
     FSSA. Pursuant to this contractual relationship, I understand 
     that SVC provides overall management, project leadership and 
     support for the Indiana State-Operated Health Insurance 
     Exchange Level One Grant Activities. You also state that SVC 
     has been a long-standing contractor to HP and its 
     predecessors-in-interest, Electronic Data Systems Corporation 
     and EDS Information Services L.L.C. You indicate that SVC and 
     HP have entered into discussions about a new contractual 
     arrangement between the parties. Generally, the draft 
     proposal you've submitted along with your request for an 
     informal advisory opinion indicates that SVC would assist HP 
     in their efforts relating to work on State's Medicaid 
     Management Information System (MMIS).
       The threshold question in this case is whether the Code of 
     Ethics applies to SVC. The Code of Ethics applies to a 
     current or former state officer, employee, and special state 
     appointee and a person who has a business relationship with 
     an agency. SVC is neither a state officer nor a special state 
     appointee. The term ``employee'' is defined in 1.C. 4-2-6-
     1(a)(8) to include an individual who contracts with an agency 
     for personal services. In this case, the contract between SVC 
     and FSSA appears to be a personal services contract. However, 
     SVC is not an individual, it is a corporation. Because SVC is 
     not an individual, SVC would not be considered to be an 
     ``employee'' as the term is defined.
       It would appear that SVC would be a ``person who has a 
     business relationship with an agency.'' Specifically, the 
     term ``person'' is defined to include a corporation. I.C. 4-
     2-6-1(a)(12). SVC is a corporation. Furthermore, a business 
     relationship includes the dealings of a person with an agency 
     seeking, obtaining, establishing, maintaining, or 
     implementing a pecuniary interest in a contract with an 
     agency. I.C. 4-2-6-1(a)(5)(A)(i). SVC has a contract with 
     FSSA, a state agency. Accordingly, the Code of Ethics would 
     apply to SVC as it applies to a ``person who has a business 
     relationship with an agency.''
       While the Code of Ethics contains fifteen rules, including 
     two that specifically address conflicts of interest, the only 
     rule in the Code of Ethics that applies to a person who has a 
     business relationship with an agency is the Donor 
     Restrictions rule set forth in 42 IAC 1-5-2. The Donor 
     Restrictions rule prohibits a person who has a business 
     relationship with an employee's agency from providing any 
     gifts, favors, services, entertainment, food, drink, travel 
     expenses or registration fees to the employee if the employee 
     would not be permitted to accept the item under 42 IAC 1-5-1, 
     the Gifts rule.
       As a person who has business relationship with an agency, 
     SVC is not subject to the conflict of interest rules set 
     forth in the Code of Ethics. Accordingly, a conflict of 
     interest under the Code of Ethics would not arise for SVC if 
     it entered into a consulting agreement with Hewlett-Packard 
     Company (``HP'') to assist HP on a contract HP has and/or 
     would have with FSSA.
       Thank you again for contacting our office. I hope this 
     information is helpful. Please note that this response does 
     not constitute an official advisory opinion. Only the State 
     Ethics Commission may issue an official advisory opinion. 
     This informal advisory opinion allows us to give you quick, 
     written advice. The Commission will consider that an employee 
     or former employee acted in good faith if it is determined 
     that the individual committed a violation after receiving 
     advice and the alleged violation was directly related to the 
     advice rendered. Also, remember that the advice given is 
     based on the facts as I understand them. If this e-mail 
     misstates facts in a material way, or omits important 
     information, please bring those inaccuracies to my attention.
           Sincerely,

                                               Cyndi Carrasco,

                                 Executive Director, Indiana State
                                                Ethics Commission.

  Mr. WYDEN. Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Moran). Under the previous order, the 
question is, Will the Senate advise and consent to the Verma 
nomination?
  Mr. WYDEN. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The assistant bill clerk called the roll.
  Mr. CORNYN. The following Senator is necessarily absent: The Senator 
from Georgia (Mr. Isakson).
  Mr. DURBIN. I announce that the Senator from Michigan (Mr. Peters) is 
necessarily absent.
  The PRESIDING OFFICER (Mr. Lankford). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced---yeas 55, nays 43, as follows:

                       [Rollcall Vote No. 86 Ex.]

                               YEAS---55

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Collins
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Donnelly
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Heitkamp
     Heller
     Hoeven
     Inhofe
     Johnson
     Kennedy
     King
     Lankford
     Lee
     Manchin
     McCain
     McConnell
     Moran
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Rubio
     Sasse
     Scott
     Shelby
     Strange
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                               NAYS---43

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Duckworth
     Durbin
     Feinstein
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Hirono
     Kaine
     Klobuchar
     Leahy
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                             NOT VOTING---2

     Isakson
     Peters
       
  The nomination was confirmed.
  The PRESIDING OFFICER. The majority leader.
  Mr. McCONNELL. Mr. President, I move to reconsider the vote, and I 
move to table the motion to reconsider.
  The PRESIDING OFFICER. The question is on agreeing to the motion to 
table.

[[Page S1772]]

  The motion was agreed to.

                          ____________________