Seema Verma, President-elect Donald Trump’s pick to lead the Centers for Medicare & Medicaid Services, will have her work cut out for her if and when she assumes leadership next year, former agency officials said this week.

Thomas Scully, a former CMS administrator under President George W. Bush, told Bloomberg BNA that Verma will face challenges in her new role, especially when it comes to changes to the Medicaid program. Scully was part of a panel of former CMS officials whose predictions for the incoming administrator were published in a Bloomberg story on Tuesday.

“There is going to be a complete and total policy war in Congress over the next few years,” Scully said.

Jonathan Blum, who served as deputy administrator for CMS from 2009 and 2014 under President Barack Obama, forecasted that Trump’s healthcare team “will be faced with difficult decisions from day one.”

Scully added that Trump’s administration is “way ahead of the game” in the health policy arena than previous administrations, with its appointment of Rep. Tom Price (R-GA) to lead HHS and extensive talk of repealing the Affordable Care Act.

Leslie Norwalk, who also served as CMS acting administrator under Bush, noted that changes to federal healthcare programs likely have to incorporate Trump’s campaign promises to create new jobs.

“If you look at what Donald Trump was saying about trade, manufacturing and jobs, there was not a lot of focus on the fact that the healthcare sector is one of the largest employers in any given state,” she told Bloomberg.

All three of the former officials agreed that Verma’s decision on how to handle the CMS Innovation Center — which some experts have predicted will see slowed funding, or even be eliminated, under Trump — will be one to watch.

“Republicans may not have liked it because they didn’t like who was controlling it,” Norwalk said. “But they may change their minds when they see the concepts that CMS is testing.”

Scully concurred, adding that many of the center’s programs “are things that Republicans have been pushing for years, bundled payments and different payment systems. Once they are aware of that, I wouldn’t be surprised if they want to keep it.”

Before becoming CMS administrator, Verma must be confirmed by the Senate, typically after hearings where she would answer questions and present her views.