For more than six years, the United States Centers for Medicare and Medicaid Services (CMS) has not had a confirmed chief administrator. That is a concerning fact - CMS is responsible for the health insurance and care of nearly one in three Americans, and has a yearly budget of more than $800 billion dollars. The Department of Defense, in comparison, has a budget of just over $500 billion dollars. With such a huge amount of money and responsibility at CMS, why has the position of head administrator remained vacant for more than half a decade?
Most analysts agree that the glaring vacancy at CMS has been due to politics. Any CMS administrator nominated by the president must first be approved by the U.S. Senate. If senators are feeling particularly unhappy with a president or his health care legislation, they are much less likely to approve a new CMS chief.
Then again, despite the current ill will toward President Obama and his Affordable Care Act, 91 senators (both Republican and Democrat) this week have finally confirmed an administrator to head the Centers for Medicare and Medicaid Services - Marilyn Tavenner.
Ms. Tavenner is a former nurse and health care worker from the state of Virginia, with more than 20 years experience at the Hospital Corporation of America. Since 2011, Tavenner has been the acting chief of CMS; carrying out the basic duties of a head administrator, without the official title or Senate confirmation. The New York Times reports that during this time at CMS, she has managed to gain the approval of Republican and Democrat legislators for her ability to work with both political parties, and to attack problems at CMS with a pragmatic, business-minded attitude.
Indeed, gaining bipartisan approval is important for a nominee to be appointed head at CMS. The last CMS chief, Mark B. McClellan, stepped down from his position in 2006. Former President George W. Bush was in office, and nominated a man named Kerry Weems to fill the role left vacant by McClellan. Although Weems brought with him a great deal of federal health administrative knowledge, having worked extensively with the Department of Health and Human Services, Democrat Senators prevented Weems from being confirmed as head of CMS.
Democrats didn't want to approve Weems because doing so would be seen as implicitly supporting Bush's recent health care legislation. Just before the Weems appointment came up for debate, Former President Bush vetoed an insurance bill that would have provided $60 billion over five years in order to enroll around 3.4 million children onto the State Health Insurance Children's Plan. In a political stand against this Bush veto, Senate Democrats refused to move forward with the confirmation of Kerry Weems as head of the Centers for Medicare and Medicaid Services.
Politics has continued to play a large role in the nominations and confirmations of CMS heads - or rather, lack of confirmations. Former President Bush was unable to get another CMS chief confirmed before leaving his position at the White House. As for the current president, Obama previously nominated one other person for the job of CMS head: a former Harvard professor named Donald Berwick. With much experience in health care management and endorsements from national medical societies, Berwick seemed like an excellent choice to head the Centers for Medicare and Medicaid Services. However, Senate Republicans thought otherwise - Berwick had publicly admitted his admiration for the British National Health Service, and therefore could not be trusted to run CMS in a fitting manner.
After Berwick's comments, such as "I am romantic about the (British) NHS. I love it," 42 U.S. Senators wrote to President Obama asking him to withdraw his nomination of Dr. Berwick. The President complied, and the hunt for an acceptable head of CMS continued.
During confirmation hearings, the newly-appointed CMS head Marilyn Tavenner also came up against a roadblock; strangely, this halt in her proceedings came from a Democrat. Senator Tom Harkin of Iowa put a hold on Tavenner's nomination, making the Senate wait an entire week before a confirmation vote could occur. Senator Harkin interrupted proceedings in order to express his disapproval of the Obama Administration's recent practice of removing money from a newly-created federal fund known as the Prevention and Public Health Fund. As one of Harkin's personal contributions to the Affordable Care Act, the senator held Tavenner's proceeding hostage in order to raise awareness about misuse of the Prevention and Public Health Fund, and to encourage the administration to stop its dipping into the fund. Once again, CMS nominee proceedings were interrupted by health care politics.
Clearly, the recent bi-partisan confirmation of Marilyn Tavenner as CMS head administrator is a long-awaited opportunity for both excitement and relief amongst CMS workers and government legislators who have bided their time for nearly seven years hoping to see an official chief confirmed to head CMS. With her strong record of cooperation and experience within CMS, politicians have good reason to expect that CMS has finally been given the chief officer it needs. Because CMS is heavily involved in advising legislators on health care laws, practices and financial matters, having a CMS head approved by 91 out of 100 Senators is an excellent sign that the U.S. Senate and the Centers for Medicare and Medicare Services will be able to work well together in the future.