Senators are planning a bipartisan policy grilling of Marilyn Tavenner this week, but they're likely to move her toward becoming the first confirmed CMS administrator since 2006.
Tavenner, acting administrator since December 2011, is not expected to face the harsh political treatment that Democrats feared her predecessor Dr. Donald Berwick would get, according to congressional sources.
“My understanding is that there's no opposition to the nomination on the Republican side,” a Republican Senate aide said on the condition of not being named. “Republicans are expected to complain about a lot of things but ultimately vote for her.”
That spirit represents a significant change for Republicans. But even if they'll no longer express their intense opposition to the law by opposing the person responsible for carrying out its provisions, they will use the forum to press Tavenner on a number of matters they've already raised in letters to Tavenner and HHS Secretary Kathleen Sebelius. Those include the use of abbreviated comment periods for complex regulations, the size of the demonstration project for dual-eligible beneficiaries, and wasteful overlap among the initiatives of various CMS offices.
“She's getting ready to take CMS through changes that are unprecedented for the nation and unprecedented in their scope—and certainly new processes for the agency,” said another Republican Senate aide. “The politics aside, there are a lot of fair policy questions that both sides will probably ask.”
Sen. Maria Cantwell (D-Wash.) has threatened to vote against Tavenner because the Obama administration has lagged in implementing a provision she advocated in 2010 healthcare law. At a February 28 hearing with one of Tavenner's subordinates, Jonathan Blum, director of the Center for Medicare at the CMS, Cantwell criticized the administration's decision to push back the “basic health option” by one year, to 2015. The provision was designed help people with incomes too high for Medicaid but who cannot afford coverage in the exchanges, even with subsidies.
“Ms. Tavenner definitely will not have my support” unless the administration shows a commitment to “live up to the way the Affordable Care Act's provisions say it should be implemented,” Cantwell said at the hearing.
Tavenner also is sure to get some pointed questions from Sen. Chuck Grassley (R-Iowa). Last week Grassley demanded an accounting of communications between the CMS and a financial consulting firm after the firm told clients that the agency was changing course on a planned cut to Medicare Advantage payments
. The firm notified them shortly before the markets closed that the agency would instead increase Medicare Advantage, which sparked a flurry of trading.
“I hope Ms. Tavenner recognizes the importance of these questions,” Grassley said on the Senate floor Monday. “I hope she comes prepared to take responsibility.”
Among the few personal questions that Tavenner is expected to face involve $160,000 a year in retirement pay she receives from her former employer HCA.
“Given the nature of hospital changes coming down the pipeline and the fact that she receives that, there may be questions about how she provides appropriate arm's-length distance,” said a Republican Senate aide. “So long as she has some sort of firewall and addresses that” then her nomination should proceed.