Front-runners in the race for Hillary Clinton's top health posts

With polls showing Hillary Clinton with a big lead in the Nov. 8 election, Democratic political insiders are looking ahead. They say she will quickly name people to top health policy positions who are diverse in gender, race, and ethnicity, have sharp administrative skills, and can work in a bipartisan way.

“If there are opportunities for bipartisanship, Hillary would be well-served to think through whether her key appointments in healthcare would help promote that bipartisanship,” said Ron Pollack, executive director of Families USA, a liberal advocacy group.

Names floated as likely contenders for HHS secretary, CMS administrator and other key posts include former Kentucky Gov. Steve Beshear, former Massachusetts Gov. Deval Patrick, Neera Tanden, Chris Jennings, Clinton policy adviser Ann O'Leary, surgeon and author Dr. Atul Gawande, and outgoing Robert Wood Johnson Foundation CEO Dr. Risa Lavizzo-Mourey. While some hope Sylvia Mathews Burwell will continue on as HHS secretary, that's considered unlikely.

Stabilizing the Affordable Care Act's struggling insurance exchanges will top the list of challenges Clinton's healthcare team will need to tackle quickly. They'll also have to lead the tricky implementation of the new Medicare physician payment system, accelerate the use of value-based payment, manage Medicaid expansion and reforms through negotiations with states, find ways to control rising prescription drug costs, and guide the implementation of the Precision Medicine Initiative and Cancer Moonshot.

With Clinton's odds of winning the presidency growing in the wake of Republican presidential candidate Donald Trump's scandal-driven meltdown, speculation is mounting about who she will select to administer health policy. Clinton and her transition team, headed by former Interior Secretary Ken Salazar, have made it a goal to increase the number of women and minorities who are hired.

Any of Clinton's picks would have to be prepared to do battle with Republicans and healthcare industry stakeholders. A number of them may be reluctant to jump back into the fray after grueling years of prior public service or because they prefer to continue more lucrative private-sector careers.

“Do these folks really want to wade back into the wars?” asked Jim Manley, a former top aide to Democratic Senate Leader Harry Reid who's now a communications strategist in Washington.

Two names that came up were former Senate Majority Leader Tom Daschle and Michael Leavitt, who was HHS secretary under George W. Bush. But Daschle, who was nominated for the post by President Barack Obama but withdrew over concerns about unpaid taxes, ruled out another bid. “Been there … tried to do that!” Daschle quipped in an email response. Leavitt, who now heads the prominent healthcare consulting firm Leavitt Partners, likewise said he's not interested. “Serving at HHS was a highlight for me, but not an experience I am interested in repeating,” he said in an email.

There is less speculation about Trump's health picks because his chance of winning is seen as small. Indeed, it's not clear who Trump's health policy advisers are. A number of veteran Republican health policy experts and former health officials say they have not been in contact with the Trump campaign or else that they do not wish to serve in a Trump administration.

Guessing who the new president's choices will be is a favorite Washington parlor game every four years. Modern Healthcare surveyed seven veteran Democratic-affiliated health policy experts, most of whom spoke on background, to find out who the leading contenders are.

Two domestic policy wonks who are widely expected to serve in top positions in a Clinton administration are Tanden, a long-time Clinton aide who now heads the Center for American Progress, a liberal think tank; and O'Leary, a senior policy adviser to the Clinton campaign. Both are serving on the campaign's transition team.

Tanden previously served as a healthcare reform adviser in the Obama White House. Before that, she oversaw policy issues for Clinton when she served in the Senate. O'Leary worked with then-Sen. Clinton on the Medicare prescription drug benefit legislation and other policy issues as her legislative director.

Another key Clinton adviser on health policy will certainly be Chris Jennings, of healthcare consultancy Jennings Policy Strategies, who worked with the Bill Clinton and Obama administrations on healthcare reform issues. “Even though I think he's not likely to seek or even accept a position, he will be the most influential person on healthcare in a Clinton administration,” Pollack said.

Observers say Burwell likely could stay on as HHS secretary if she wanted, since she's widely seen as doing an excellent job and is popular among both Republicans and Democrats. But some say she seeks fresh challenges, and that she could be Clinton's pick for Treasury secretary.

“One can only hope Burwell will move to another cabinet position; she's fantastic,” Manley said. “We don't know what she wants to do.”

Other frequently mentioned names are:

Nancy-Ann DeParle, a key health policy official in the Bill Clinton and Obama administrations.

David Cutler, a Harvard University economics professor who served in the Bill Clinton administration and advised the Obama White House on health policy.

Dr. Kavita Patel, a Johns Hopkins Medicine internist who served as a senior aide in the Obama White House.

Dr. Julian Harris, who served as associate director for health at the Office of Management and Budget in the Obama administration and previously served as Medicaid director in Massachusetts.

Dr. Ezekiel Emanuel, a University of Pennsylvania professor of medical ethics who served as health policy adviser to the Obama administration.

Peter Lee, executive director of the California Health Benefit Exchange and a former HHS official in the Obama administration.

Andy Slavitt, the acting CMS administrator who played a key role in fixing the portal HealthCare.gov after its disastrous launch.

Dr. Patrick Conway, the CMS chief medical officer who also heads the CMS Innovation Center.

Liz Fowler, a former top Senate staffer who was a key drafter of the Affordable Care Act.

Pollack predicted that Clinton and her transition team will give preference to someone with strong administrative skills to lead HHS, given the early leadership problems in rolling out the Affordable Care Act. That's why he thinks Clinton will pick someone like Beshear or former Michigan Gov. Jennifer Granholm, who is serving on the transition team.

“My guess is the inclination will be to select a governor because as we've seen it's not just important to have someone strong on substance and policy, but it's also critically important to have someone sound on administration,” he said.