Ms. Verna's record suggests the program could change in other ways, too. She worked closely with officials in Indiana (including Vice President-elect Mike Pence) on that state's ACA Medicaid expansion. Unlike other states, Indiana got permission from CMS to require that beneficiaries — even those with extremely low incomes — pay premiums if they want full benefits. If they don't, they can be frozen out of coverage for up to six months. The program is a complex blending of insurance choices, health savings accounts and co-pays, and though it has led to increased coverage, it has not made Indiana appreciably healthier — the state ranked 33rd healthiest in 2006, before the expansion, and 41st in 2015, according to America's Health Rankings, a long-established annual report produced by United Health Foundation and the American Public Health Association. Those who worked with Ms. Verna in Indiana and other states that sought to replicate its model said she was extremely well versed in the details of federal policy so that she could fit this square peg into Medicaid's round hole. Now she will be in charge of setting that policy.