President-elect Donald Trump announced his picks for the biggest roles at the Department of Health and Human Services on Tuesday, naming Rep. Tom Price as the new health secretary and healthcare consultant Seema Verma as lead administrator of the Centers for Medicare & Medicaid Services (CMS). The two selections offer some insight into the role Vice-President-elect Mike Pence plays in shaping the cabinet, and the potential battle that may loom for government health care.

Verma has an extensive history in the healthcare industry. Her consulting firm, SVC Inc., worked alongside Pence to reform Indiana’s Medicaid program following the induction of President Barack Obama’s Affordable Care Act (ACA). Verma’s new appointment will require her to oversee and advance the Medicare, Medicaid and Children’s Health Insurance Program (CHIP), but her industry track record has been largely favored by conservatives interested in phasing out government healthcare programs, making Trump’s CMS pick a rather contentious one for the more than 100 million people covered by Medicare, Medicaid and the ACA.  

While Pence was governor of Indiana, Verma helped create Healthy Indiana Plan 2.0, which required users, including low-income recipients, to make monthly payments for their health insurance services with restrictions that warranted a six-month lockout from coverage if even a single payment was missed.

National Health Law Program policy analyst David Machledt told NPR that the provisions Verma curated for HIP 2.0 block people from getting the health coverage that they need. About 410,000 people in Indiana are currently covered by HIP 2.0.

“Early evaluations show that a lot of people don’t understand this plan and don’t understand the incentives in it,” he said, adding that proposals like Verma’s Indiana coverage program, which is also favored by Republican-dominated states like Iowa, Kentucky and Ohio, could result in harsher provisions throughout the country.

Along with Price, an orthopedic surgeon and chief sponsor of an ACA-repeal bill that Obama vetoed in 2015 and an outspoken proponent of reducing healthcare funding, Trump’s promise to bring down the ACA and reshape the other two health care entitlement programs could become reality.

Trump transition spokesperson Jason Miller told reporters on Tuesday that Trump intends to expand the use of health-savings accounts, which would allow insurers to sell policies across state lines, and reform Medicaid from an entitlement program by cutting grants and reducing federal rules.

Confirmation for cabinet appointments will begin in January. It takes a majority of senators to confirm a cabinet member, and the Republicans will have 52 seats in the incoming Senate.