Confirmation decision on Tavenner at CMS comes at crucial time

The agency overseeing implementation of most of the 2010 healthcare overhaul may finally be getting a confirmed leader, and it comes at a critical time for that complex effort and the future of Medicare and Medicaid.

Acting CMS Administrator Marilyn Tavenner's April 9 confirmation hearing as CMS administrator puts her on course to become its first Senate-approved leader in more than six years.

“Considering CMS' current goals of ACA and Medicare reform implementation, there never has been a more important time in the history of the agency to have a leader with the full authority which comes with U.S. Senate approval as administrator,” said Chip Kahn, president and CEO of the Federation of American Hospitals.

The political outlook for Tavenner remains unclear. In recent weeks, Senate Republicans have voiced cautious optimism that they could support her but none have promised to do so. They have sufficient votes to filibuster Tavenner if they choose that tactic.

Tom Miller, scholar at the libertarian American Enterprise Institute, told Modern Healthcare that Tavenner’s path may have been eased by the Obama administration’s recent reversal of planned cuts to Medicare Advantage plans, which Republicans feared would lead to mass dissolution of the popular plans. “The only question is whether another senator or two needs to exact an additional pound of political flesh before grudgingly waiving Tavenner through,” he said.

Confirmation is important, according to healthcare lobbyists and advocates, because it will provide the stature needed to implement the many complex and sometimes controversial elements of the Patient Protection and Affordable Care Act. A permanent agency head also may play a stronger role in thorny healthcare policy debates, such as pushing to roll back spending cuts under the budget sequester.

“We face tremendous challenges with issues such as sequestration and health reform implementation,” said Anders Gilberg, senior vice president of government affairs for the MGMA. “It's critical to have stability in the form of an experienced leader at the CMS' helm to navigate the agency through these difficult times.”

The agency already oversees more than $800 billion in annual spending on Medicare and Medicaid programs, which pay for healthcare for more than 100 million people. The healthcare law makes myriad changes to those programs to try to move the nation's healthcare system toward paying for quality, instead of quantity.

Further changes to the two programs, which make up 23% of the federal budget, are likely to be central to the brewing federal debt reduction fight this year between Congress and the Obama administration since healthcare spending is widely seen as driving annual deficits.

As acting administrator of the agency since the 2011 departure of Dr. Donald Berwick, Tavenner has already overseen implementation of many components of the 2010 healthcare overhaul, such as the launch of Medicare accountable care organizations. But the marquee initiatives—expansion of Medicaid and the creation of health insurance exchanges—don't start until 2014.

Democrats never gave Berwick a confirmation hearing. Throughout his tenure Republicans continued to criticize his past statements praising the U.K.'s National Health Service. And in the run-up to the 2012 elections, Democrats feared a confirmation hearing for Tavenner would become a venue for criticism of the Affordable Care Act, which has never achieved majority popular support, according to national polls.

Tavenner received support this week from at least one Republican: Mark McClellan. McClellan, the last confirmed CMS administrator, resigned in 2006.

“I am glad to hear that Marilyn Tavenner has a hearing scheduled,” McClellan, currently director of the Engelberg Center for Health Care Reform at the Brookings Institution, told Modern Healthcare. “Having a confirmed administrator makes a real difference at CMS, and as I've said before, Marilyn is very well qualified.”