Her agency, which spends more than $1 trillion a year on programs providing health care to more than one-third of all Americans is the biggest within the Department of Health and Human Services. Since Ms. Verma took the helm, she has advocated repealing the Affordable Care Act and, short of that, reining in the law’s expansion of Medicaid to millions of low-income adults.

Working with Mr. Pence in Indiana, she was an architect of that state’s conservative approach to Medicaid expansion, which emphasized “personal responsibility” by requiring many beneficiaries to pay premiums or risk being locked out of coverage for six months.

At C.M.S., Ms. Verma has encouraged states to require many of the adults who became eligible for Medicaid through the Affordable Care Act to work, volunteer or train for a job, and prove to their state that they are doing so, or lose coverage. Those “work requirements” have been struck down by several courts for failing to comport with the objective of Medicaid as defined under federal law — providing health coverage to the poor.

Her relationship with Alex M. Azar II, the health and human services secretary, has been rocky, to the point that the White House stepped in to mediate late last year. She also came under fire from Democrats for spending several million dollars on public relations contracts that were partly meant to raise her public profile; the contracts are now under review by the department’s inspector general.

Ms. Verma, 49, founded a health policy consulting firm, SVC Inc., in 2001, which also advised Kentucky and Ohio on how to shape their Medicaid expansion programs and worked with a number of other states. After her confirmation as administrator of C.M.S., she sold the company to Health Management Associates.

A first-generation American whose parents immigrated from India, Ms. Verma was born in Virginia and has listed Missouri, the Washington, D.C. suburbs and Taiwan as places she lived earlier in life. She graduated from the University of Maryland and has a masters in public health from Johns Hopkins University.

— Abby Goodnough

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