Seema Verma, the nominee to become administrator of the Centers for Medicare and Medicaid Services, speaks during a Senate Finance Committee confirmation hearing on Feb. 16. (Pete Marovich/Bloomberg News)

A sharply divided Senate Finance Committee on Thursday morning recommended the confirmation of Seema Verma, a health-care consultant who has reshaped Medicaid in several states, to run the nation’s Medicare and Medicaid programs.

On a vote of 13 to 12, with every Democrat in opposition, Verma’s nomination now moves to the full Senate, where the Republican majority has been moving swiftly to give its seal of approval to each of President Trump’s nominees who have come to a floor vote.

Within the sprawling Health and Human Services Department, the Centers for Medicare and Medicaid Services is a powerhouse, overseeing about $1 trillion in spending on the two vast entitlement programs. For the past seven years, the agency also has carried out most of the implementation of the Affordable Care Act (ACA), which Trump and others in the GOP are working to demolish and replace with more conservative health policies.

During the past six years, Verma’s Indianapolis-based consulting firm, SVC Inc., has held contracts totaling nearly $8 million with the state of Indiana, according to information she disclosed as part of the confirmation process. She led the Hoosier state’s successful effort to secure federal permission to expand Medicaid under the ACA in an unusual way, an effort that the state started a few years before the law existed. Under Indiana’s version of Medicaid, everyone who receives benefits, including the very poor, is required to pay monthly premiums and the contributions are invested in health savings accounts. Very poor people who do not make the payments are bumped down to a lower tier of coverage, while people with slightly more income are removed from the program.

At her confirmation hearing before the Senate Finance Committee two weeks ago, Verma was questioned about her views on an array of major issues that would be within her domain as CMS administrator — among them, how the agency could try to lower drug prices, how it could improve residents’ access to care in rural America, and whether she would favor a nationwide extension of Indiana’s freeze-out from Medicaid of people who do not pay their monthly fee. She largely sidestepped the questions.

During a brief debate Wednesday before Thursday’s committee vote, Sen. Ron Wyden (Ore.), the committee’s ranking Democrat, said that her responses at the hearing and to written follow-up questions were “a lot of happy talk that didn’t amount to much substance.” He contended that she “was simply able to skirt Indiana’s relaxed conflict of interest rules,” holding her main consultant’s contract while taking fees from other vendors who worked on the state’s Medicaid program.

Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) countered that Verma would provide “experienced and responsible leadership” in working with Congress on “the challenges plaguing both Medicare and Medicaid . . . to improve these programs and help enact the necessary reforms to ensure their solvency for future generations.”