Reform Update: Week marked by another high-profile exit

The Obama administration lost another one of its top healthcare officials just as HHS prepares to kick implementation of the 2010 healthcare reform law into high gear.

A little more than a week after CMS Administrator Marilyn Tavenner told her staff that Dr. Rick Gilfillan, director of the CMS Innovation Center, will leave this month, an HHS spokeswoman confirmed that U.S. Surgeon General Dr. Regina Benjamin will step down from her post in July. Benjamin, who was appointed by President Barack Obama in July 2009, was not available for an interview.

“The surgeon general has indicated that she's going to spend some time this summer volunteering at her clinic in Alabama, allowing her to get back in touch with her patients that she has greatly missed,” HHS Spokeswoman Dori Salcido said in an e-mail. Benjamin opened the Bayou Le Batre Rural Health Clinic in the 1980s.

Salcido added that Deputy Surgeon General Boris Lushniak, 53, will serve as acting surgeon general after the 56-year-old Benjamin leaves on July 16 and a search begins for her successor.

Jeffrey Levi, executive director at the Trust for America's Health, has worked with Benjamin on the National Prevention Council, which the 2010 Patient Protection and Affordable Care Act established. Obama appointed Levi as a member of the council's advisory group on prevention, health promotion and integrative and public health in January 2011, and Benjamin appointed him to chair the group three months later. In an interview, Levi said Benjamin has framed policy solutions at a population level and managed to address those solutions through the prism of her patient population in Alabama.

“She's an incredibly committed clinician who has taken that clinical experience and drawn from it a recognition that if we don't think about what happens outside the clinic, we will never be able to address some of the most pressing needs inside the clinic, especially racial and ethnic minorities and those who are underserved,” Levi told Modern Healthcare.

Benjamin has been criticized in the news for her weight, given that she serves as the nation's physician and figurehead for public health. “I think she's demonstrated through her walking campaign that this is about being fit and being healthy and not about a particular size,” Levi said, referring to the “Every Body Walk” initiative that she announced as part of National Public Health Week in April to get Americans walking again.

Looking ahead, Levi explained what he hopes Benjamin's successor will bring to the role of surgeon general. “I think a similar passion around prevention,” he said. “A recognition that the new surgeon general will take office as we implement the Affordable Care Act, keeping uppermost in everyone's mind in the administration and country at large that the clinical and the community are inextricably tied.”

Immigration reform took center stage in Congress this week as the Senate began floor debate on the Border Security, Economic Opportunity and Immigration Modernization Act, the comprehensive bill from the Senate's Gang of Eight that the Senate Judiciary Committee passed last month. Flanked by top leaders representing business, labor and law enforcement, Obama endorsed the legislation in a speech from the White House East Room on June 11. The White House formally supported the bill later that day in a statement of administration policy that said the legislation doesn't include every element the administration has called for, but “encompasses the principles that the president has made clear need to be a part of commonsense immigration reform.” Meanwhile, Sen. Barbara Boxer (D-Calif.) told a group of California reporters on Thursday that she plans to offer an amendment that would provide $250 million—and possibly more—to help state and local governments pay the cost of healthcare for uninsured immigrants who are seeking legal status, according to a spokesman in Boxer's office.

The House Oversight and Government Reform Committee sent an eight-page letter to HHS Secretary Kathleen Sebelius that asks for transcribed interviews of HHS officials who the committee says have provided the panel conflicting information about the administration's outreach efforts to implement the Affordable Care Act. The lawmakers wrote that they asked Sebelius questions in April and May about the funding for exchanges and the establishment of the navigators program and have yet to receive a response.

Douglas Elmendorf, director of the Congressional Budget Office, provided an update to Congress about when the CBO will offer its major reports for the rest of the year. Elmendorf explained in a letter to lawmakers that the CBO released its 10-year projections in May of this year, rather than March, because Obama's budget was released much later than expected. As a result, the CBO will now release its long-term budget projections—which are based on the 10-year projections and normally released in June—in September. A more notable change, Elmendorf wrote, is that the CBO will not update its 10-year budget projections that typically come out in August. “Because CBO's spring update to the 10-year budget projections was done so recently and because the agency is facing many demands on its limited resources—for analyses of major immigration legislation, for example—CBO will not issue new budget and economic projections in August.”

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