Amid a generally warm bipartisan welcome today, Marilyn Tavenner fielded questions and concerns over implementation of the Patient Protection and Affordable Care Act from members of the Senate Finance Committee.
Much of the partisan rancor that has dominated health policy discussions in Congress since it began considering the ACA in 2009 died away during Tavenner's confirmation hearing as administrator of the CMS. Instead, most members of both parties lavished the acting administrator with praise for the experience she has brought to administering an agency that oversees $820 billion in annual healthcare spending.
The bipartisan goodwill began with House Majority Leader and fellow Virginian Eric Cantor's introduction of Tavenner as someone who approaches healthcare from the patient's perspective. Sen. Orrin Hatch (R-Utah), ranking member of the Finance Committee, and a staunch opponent of the 2010 healthcare law said Tavenner is “up to the challenge” of running the CMS and supports her nomination.
Among the few issues raised by senators that could affect Tavenner's nomination was Sen. Chuck Grassley's (R-Iowa) concern over a possible CMS leak of pending Medicare Advantage rate increases recently. Tavenner characterized the possible rate reversal leak to Wall Street as a "huge issue" that has resulted in both CMS and HHS inspector general's office investigations.
Additionally, Tavenner addressed the possible conflict of her ongoing annual retirement payments of more than $160,000 from the HCA by telling senators that she has recused herself from any issues specifically involving that health system. However, she does not recuse herself from policy questions affecting all hospitals, she said.
In one of the several indications of the solid prospects for her confirmation, Tavenner pushed back against the repeated requests of Sen. Max Baucus (D-Mont.) that her agency set specific public timeframes for moving Medicare away from a fee-for-service payment system.
“I would be very nervous about setting an arbitrary target,” Tavenner said.
One area where Tavenner said action is needed is to increase the transparency on prices charged by hospitals. Some recent reports have questioned the seeming disconnect between hospitals' so-called charge master prices and the cost of providing those services, drugs or devices.
Among the transparency initiatives the CMS is developing is a push to publish hospital prices and “do some comparison” of them, she said. Additionally, the CMS plans to encourage states to develop programs that examine the connection between hospital charges and the costs of those items or services.
Panel members also pressed Tavenner on contentious policy issues overseen by the CMS.
When senators criticized the agency's opacity on myriad issues related to the launch of health insurance exchanges, Tavenner committed to biweekly updates on their progress, some of which may be released publicly.
Additionally, Tavenner confirmed the recent commitment of HHS Secretary Kathleen Sebelius to Sen. Maria Cantwell (D-Wash.) that the CMS will issue rules for the delayed Basic Health Plan by April 15. Cantwell had threatened to withhold her support of Tavenner without advances in the program that aims to further subsidize insurance costs for exchange enrollees who are unable to afford coverage even with the standard assistance provided by the law.
Among the agency's other planned ACA implementation steps is the likely limitation of premium assistance variations to its standard Medicaid expansion to a “handful” of states. The highest profile of such Medicaid expansion variation is in Arkansas, for which Tavenner cautioned, "we haven't approved anything."
The Arkansas approach drew criticism from Sen. Jay Rockefeller (D-W.Va.) over concerns it would allow broad cost sharing and service limitations on Medicaid beneficiaries.
Regarding various insurance provisions of the healthcare law, Tavenner indicated an increased tempo for her agency.
For example, the CMS may utilize ACA authority in “a couple” states to take over implementation of insurance reforms when state regulators don't act, Tavenner said. Separately, the agency is entering the public outreach “stage” of its launch of health insurance exchanges, during which federal officials aim to alert millions of potentially eligible enrollees of coverage options and that they are required to obtain qualifying insurance coverage.
Although Tavenner's nomination is expected to advance quickly, Baucus has yet to set a date for a committee vote.
“That's my plan,” Baucus said when another committee member urged her quick approval.
The soonest the committee could vote is a week from today.