Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Health Team May Stay Steady in Key Phase of Overhaul Implementation

By John Reichard, CQ HealthBeat Editor

November 8, 2012 -- Look for the Obama administration to pretty much put the same health team onto the field in 2013 as it marches closer to the historic start of coverage expansion under the health law a little more than a year from now.

But that doesn't mean the lineup won't change at all.

With the election a scant two days old and the administration's disciplined press operation keeping its metaphorical mouth firmly shut, the usual post-election analysis of possible personnel changes relies heavily on the observations of longtime watchers of, and former officials with, the federal agencies that carry out the nation's health policy.

The end of one presidential term and the impending start of another is a natural point for people to move on. So the utter silence about potential changes may be telling and suggest stability at the top.

Clearly, there are strong reasons to keep the team together after the judicial and election campaign challenges it has successfully weathered. It now has a real shot at actually extending coverage to tens of millions of uninsured Americans after decades of fruitless attempts by universal coverage advocates to do so. There's little or no talk thus far that Health and Human Services (HHS) Secretary Kathleen Sebelius is on her way out, particularly with the possibility that her legacy would be burnished by seeing through the job of implementing the health law if she does stay.

But four years as HHS secretary is a long time. Staying through a second term would be highly unusual. "Only one HHS secretary has stayed on that long, and the job was much easier then," said a former administration official, referring to the tenure of Donna Shalala as head of HHS during the eight years of the Clinton administration. "As for Sebelius, it's hard to say," the former official adds. "She's got a helluva lot of energy and wants to see things through, so I expect she'll stay for at least part of a second term."

The officials who oversee HHS in the White House also are known as steady long-term performers with a deep commitment to the health law. They include Deputy White House Chief of Staff Nancy Ann DeParle and Jeanne Lambrew, deputy assistant to the president for health policy, as well as former Senate Finance Committee staffer Elizabeth Fowler, special assistant to the president for health care and economic policy on the National Economic Council.

It's unclear whether Mike Hash, who also served as part of the White House team and is now director of the HHS Office of Health Reform, will stay on or return to the private sector.

Steadiness is also the hallmark of acting Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner, who has strong ties to the hospital industry, to centrists like Sen. Mark Warner, D-Va., and even to Republicans such as House Majority Leader Eric Cantor, R-Va. With as many as 55 senators in the new Senate part of the Democratic caucus, Tavenner could be a good bet to be confirmed as permanent administrator. That's particularly so if Republicans retreat from their strategy of blocking the health law at every opportunity in Congress after their strategy of trying to repeal the overhaul failed to win them the White House and control of the Senate.

"Marilyn has an excellent shot at confirmation now," says Dan Mendelson, top health budget official in the Clinton White House. "She is a centrist, respected by both sides of the aisle, and would be a good partner in the upcoming discussions of deficit reduction, as well as reform implementation."

That view about Tavenner's confirmation prospects is shared by Tom Scully, who ran CMS during the George W. Bush administration.
Mendelson sums up the likelihood that no major reshuffle is in the works this way:

"Getting the exchanges and the Medicaid expansion up and running is a monumental task, and the pace is accelerating after the election. The health care team has the confidence of the White House, and Nancy Ann is able to control the issues of most importance to her. So while there might be a few tired people leaving and members of the core team being elevated, we are unlikely to see a major shake-up."

Rich Tarplin of Tarplin Strategies, a lobbyist with ties to many Obama administration officials, sees the second term in much the same way. "This is an amazing team that's served four years in the reform trenches, so changes are inevitable," says Tarplin, who served as assistant secretary for legislation at HHS in the Clinton administration. "That's always part of the transition to a second term. But the team has a very deep bench, so there'll be a lot of continuity as implementation moves forward."

What about other agencies?

National Institutes of Health Director Francis Collins and Centers for Disease Control Director Thomas Frieden face the difficult task of potentially having to oversee sharp reductions to their budgets. But Collins is widely viewed as a star and as one who loves his job. And he may be able to hold the budget cutters at bay. Frieden is a similarly passionate public servant and has proven to be a durable fighter in taking on powerful industries during his public health career. Those qualities suggest he would like to stay on.

Mary Wakefield, administrator of the Health Resources and Services Administration, faces a year in which Congress is expected to reauthorize a key program overseen by her agency, the Ryan White program, which funds services and treatments for those with the AIDS virus or full-blown AIDS. But there are no signs that the highly energetic Wakefield has lost any interest in her position and its challenges.

Less certain perhaps is the fate of Margaret Hamburg, commissioner of the Food and Drug Administration (FDA). Running FDA is a highly stressful job. In the past, two years has been about the half life of an agency commissioner.

Longtime FDA watcher Steve Grossman, a former Hill staffer who now runs HPS Group, a health policy consulting firm, said, "I think Margaret Hamburg is probably on solid ground to stay as long as she wants. However, it is not clear that she intends to stay."

Grossman, a health aide from 1979 to 1985 on the Senate Labor and Human Resources Committee, the predecessor to the Senate HELP Committee, added, however, that "there is going to be a significant amount of turnover in the administration. History tells us this is true, no matter how it looks a few days after Election Day. The evaluation of existing personnel is an ongoing process, and we can guess that she is safe, but there is no way to really know."

Publication Details