Senate confirmation of the nominee to head the CMS is critical to the continued implementation of the healthcare reform law, and early signs indicate that Marilyn Tavenner is likely to get it.
CMS succession plan
Tavenner's confirmation prospects appear bright
Tavenner, formerly the CMS' second-in-command, took the helm at the agency Dec. 2 when Dr. Donald Berwick resigned his post. She is much less well known than Berwick, a longtime advocate of overhauling the U.S. healthcare system who drew Republican opposition over his praise of the British socialized healthcare system. The opposition was significant enough that Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, which has jurisdiction over the nomination of the CMS administrator, declined even to hold a hearing on Berwick.
So far, Baucus has issued no public positions on Tavenner, and his staff said any hearing will await the arrival of her background documents from the White House.
But some of her supporters see indications that she may face significantly less Republican opposition because of her lower-key personal style.
For instance, Sen. Tom Carper (D-Del.), a member of the Finance Committee, said in an interview with Modern Healthcare that he was encouraged by House Majority Leader Eric Cantor's (R-Va.) recent comments to the Associated Press supporting her confirmation. “I might be wrong here, but I feel like in the last couple of months, we're less gridlocked here and less partisan,” Carper said.
Tavenner's nomination has generally drawn either a muted or a wait-and-see response from Senate Republicans, including Sen. Orrin Hatch (R-Utah), the ranking member of the panel with jurisdiction over her nomination.
“Any nominee to a federal agency with this much power and authority over the lives of millions of Americans must be carefully scrutinized,” Hatch said in a written statement. “Republicans on the Finance Committee look forward to examining her record and gaining an understanding of her views of Medicare, Medicaid and the president's health law.”
Chip Kahn, president and CEO of the Federation of American Hospitals, said the lack of immediate opposition from Republicans and their desire for hearings are good signs that Tavenner is not a lightning rod for another partisan fight. Kahn, who has known Tavenner for 10 years, said her Capitol Hill interactions with Republicans will play to her deft personal touch.
“One thing that's clear is that she knows how to work across the aisle,” Kahn said, which he said was displayed in her former role as Virginia's secretary of health and human resources under former Gov. Tim Kaine. “She did that when she worked in the state of Virginia, and to the extent she could, she's been very open to people up here.”
Joseph Antos, a healthcare and retirement policy scholar at the conservative American Enterprise Institute, agreed that Tavenner's “substantial” public and private management experience will help her to effectively manage the CMS. Another mark in her favor is her perceived lack of ideological unity with President Barack Obama.
“Unlike Don, Marilyn is not the person Obama wanted to implement the CMS portions of health reform, so she will have less independence,” Antos said in an e-mail. Antos said he expects Cantor's endorsement to help Tavenner and gives her a 50-50 chance of receiving confirmation.
Supporters said Tavenner will need the Senate's seal of approval—instead of time-limited recess appointments—to effectively do her job.
“I thought Dr. Berwick did an exceptional job for someone who was not confirmed,” Carper said. “While I will miss his skills, ability and knowledge, there is probably some value to knowing that the person in that job isn't just going to be there for a short period of time but could be there for several years.”
Kahn said “a fully nominated and confirmed CMS administrator is one of the most powerful positions in the whole government” and could help with several aspects of her job, including possibly speeding up the issuance of the myriad regulations implementing the healthcare law, which have frequently fallen behind schedule.
Prior to any confirmation vote, Republicans are expected to “thoroughly” review Tavenner's record and could focus in on some questions in her past, Antos said. Primary among these were reports in the Richmond Times-Dispatch on her role in the sale of public children's mental health facilities to a private company before her 2010 departure from the Virginia health department post. The publication cited her “questionable” role in altering experts' analyses on whether the state needed those facilities.
Although the White House and HHS had no response to questions about those transactions, it's an issue that government officials said they expect to arise in the confirmation process. However, officials at two national mental health advocacy organizations told Modern Healthcare the deals had not raised concerns for them.
Several Senate Democratic healthcare leaders Modern Healthcare asked about Tavenner, including Sen. Herb Kohl (D-Wis.), said they had not received enough information to take a position on her. Other Democrats and provider advocates strongly supported her. “Her experience is very impressive and I am prepared to support her,” said Richard Blumenthal (D-Conn.), a member of the Finance Committee.
Blumenthal's enthusiasm was echoed by a number of provider and patient advocates after the Nov. 28 announcement that she would assume interim leadership of the CMS.
“Marilyn Tavenner's experiences as a nurse, hospital administrator, Medicaid official and principal deputy administrator at CMS give her the versatility and vision to lead CMS through healthcare reform implementation,” Dr. David Seaberg, president of the American College of Emergency Physicians, said in a written statement.
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