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White House Renominates Tavenner to Head CMS

By John Reichard and Dena Bunis, CQ HealthBeat

February 7, 2013 – The White House renominated Marilyn Tavenner to head the Centers for Medicare and Medicaid Services (CMS) last week, hoping to put a permanent administrator atop the agency for the first time in seven years.

If ever there was a time to try to obtain Senate confirmation of Tavenner to head the agency it's now. With the health care law moving toward implementation after the Supreme Court upheld its constitutionality in 2012 and the next election 21 months away, Republicans may be less inclined to vote against her as a way of registering their fierce opposition to the overhaul.

They would almost certainly would use a Senate Finance Committee confirmation hearing to attack the law and raise questions about its viability. They would also likely seize the opportunity to call for major changes in Medicare and Medicaid. But the 61-year-old Tavenner—a former nurse and for-profit hospital industry executive who was well liked by her peers, many of them Republicans—isn't the lightning rod for criticism of the law that former CMS Administrator Donald M. Berwick was when the White House unsuccessfully nominated him to head the agency.

Facing heated Republican opposition to the Berwick nomination, Senate Finance Committee Chairman Max Baucus, D-Mont., never scheduled a confirmation hearing for Berwick. And with the 2012 election less than a year away, he didn't hold one for Tavenner either after the White House announced its intention to nominate her on Nov. 23, 2011. She started as acting administrator on Dec. 5.

The White House had barely sent out the notice of Tavenner's reappointment when health groups began calling for a confirmation hearing. And Republicans signaled a willingness to hear the acting administrator out.

"On behalf of the 45,000 members of the American Association of Nurse Anesthetists, I write to urge the Senate to schedule hearings and votes to confirm the President's nominee for Administrator of the Centers for Medicare & Medicaid Services (CMS), Ms. Marilyn Tavenner,'' Janice Izlar, president of the association, wrote in a letter to Majority Leader Harry Reid, Minority Leader Mitch McConnell Baucus and Finance ranking member Orrin G. Hatch. "As critical as CMS is to the life and health of every American and to the fiscal state of the country, the nation's interest is best served by the agency being led by an Administrator who carries the full responsibility and authority of the position leaders of the Finance."

Similar sentiments came in statements from Families USA, the Federation of American Hospitals, the American Hospital Association and the American Medical Association.

Neither Reid nor Baucus had any immediate reaction to the president's renomination.

Senators Want to Question Tavenner at Hearing

When told of the president's renomination and asked if he would support Tavenner's confirmation, McConnell, in a brief interview off the Senate floor, said that "I really haven't given it any thought at all.''

Hatch, who has said in the past that he had a "favorable" opinion of Tavenner, reiterated those sentiments even as he said he will have questions for the nominee.

"I've met with Ms. Tavenner and found her to be smart and diligent,'' Hatch said in a statement. "With Medicare and Medicaid on an unsustainable fiscal path, the cost of health care continuing to rise, and with the implementation of the health law moving forward, there are many questions she'll need to fully answer before I decide whether or not to support her nomination."

Even one Democrat who strongly supports Medicare and Medicaid and is an ardent backer of the health care law (PL 111-148, PL 111-152) didn't rush to demand an immediate confirmation when told of the president's renomination.

"I'm going to have to have some discussions with her,'' Sen. Tom Harkin, chairman of the Health, Education, Labor and Pensions Committee, said in an interview at the Capitol. The Iowa Democrat said he has had some concerns about "how CMS interprets certain things which sometimes don't seem to make sense."

Sen. Charles E. Grassley, Jr., a senior Republican on the Finance Committee, urged regular order for this nomination. "I hope the Obama administration supports the nomination going through the committee process and avoids the divisive, unconstitutional circumvention through recess appointment as it tried with the previous nomination of Donald Berwick to head the Centers for Medicare and Medicaid Services," Grassley said in a statement. "It's been seven years since this massive federal agency has had a Senate-confirmed administrator. The Senate should give Ms. Tavenner every opportunity to show she is a worthy choice to lead the agency."

Asked whether Republicans would likely hold up a Tavenner confirmation on the floor, a Senate GOP aide said. "I don't see it coming. I don't see any reason anyone is going to put a hold on it," absent some unforeseen revelation.

The aide said he expected her to be confirmed. "If she's got a Daschle-type problem of course not,'' the aide added, referring to tax issues that derailed former Majority Leader Tom Daschle's bid for HHS secretary. Asked about timing for a confirmation hearing, the aide said that Jack Lew is first up for Treasury Secretary and "then after that then maybe we go directly" to Tavenner, perhaps in the work period between Feb. 26 and March 22.

Tavenner has won plaudits as a steady, productive manager ever since joining the agency in February 2010 as its top operating executive.
A Virginian, Tavenner is well liked by such moderates as Mark Warner and Tim Kaine, the two Democratic senators from her state. She also has drawn praise from the right, with House Majority Leader Eric Cantor, R-Va., calling her a good choice to run CMS.

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