CMS Administrator Marilyn Tavenner's announcement last Friday that she's leaving the CMS at the end of February kicked off speculation on whom President Barack Obama will nominate to replace her. Perhaps a bigger question is whether any Obama nominee can gain approval from the GOP-controlled Senate.
Her immediate replacement, at least on an interim basis, will be Andy Slavitt, a former UnitedHealth Group executive who is now principal deputy administrator. Tavenner, 63, spent more than three years in the post and has been with the CMS for more than five years.
Slavitt's was the only name publicly mentioned late last week as a possible permanent replacement.
“I think it's going to be very hard to get someone confirmed into this role,” said Dr. Scott Gottlieb, a scholar with the American Enterprise Institute, a conservative think tank. “I wouldn't be surprised to see someone act in the role for a prolonged period and then be appointed for the final year during a recess.” He called her “responsive” to congressional Republicans, indicating it may be difficult to find a successor with her political relationships.
Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor & Pensions Committee, put his stake in the ground regarding a potential replacement.
“I urge the president to nominate someone to replace Ms. Tavenner who will work with Congress to make the structural reforms necessary so that seniors can count on Medicare to pay their hospital bills,” he said in a statement, referencing specifically his Fiscal Sustainability Act, which would trim federal Medicare and Medicaid spending by $739 billion over the next 10 years.
Tavenner had apparently discussed leaving with at least one close associate. Tom Scully, a former CMS administrator and current general partner at investment firm Welsh, Carson, Anderson & Stowe, said that he was “surprised she didn't leave earlier.”
Scully, who considers Tavenner a friend and a talented administrator, said she had told him she was considering leaving earlier due to the job's intense pressures.
Until there is a permanent replacement, the role will fall to Slavitt and the current deputies, who Scully said he feels are up to the challenges CMS faces—including implementing ICD-10, meaningful use and interoperability. “Marilyn is uniquely talented, but they've got a pretty good bench,” he said.
Joel Ario, a former CMS official and current managing director at Manatt Health Solutions, echoed Scully's praise of Tavenner. At the same time, he said Slavitt “should be confirmable as well if Congress is interested in competence.”
A CMS spokesman said of Tavenner's departure, “She has been working a 24/7 job for five years. This was a decision that Marilyn came to, deciding to stay through the second open enrollment. After five grueling years, she was ready for a break and a change.”
Dr. Farzad Mostashari, whose tenure as head of the Office of the National Coordinator for Health Information Technology coincided with much of Tavenner's at the CMS said, “I'm not surprised at all (about) her taking a breather after a very intense period” in CMS history … (The job requires) “a lot of mental toughness, which Marilyn has in spades.”
Sen. Tom Carper (D-Del.), who sits on the Senate Finance Committee, said “the launch of HealthCare.gov was difficult, but Administrator Tavenner was tirelessly committed to correcting the course.”