Head of CMS Steps Down

The day before Thanksgiving, the administrator of the Centers for Medicare and Medicaid Services (CMS), Donald M. Berwick, announced plans to step down, nearly a month before the expiration of his recess appointment. He left his post on Dec. 2.

“Don Berwick did outstanding work at CMS,” White House deputy press secretary Jamie Smith said. “It’s unfortunate that a small group of senators obstructed his nomination, putting political interests above the best interests of the American people.”

President Obama nominated Berwick to run Medicare in April 2010. In July 2010, with no confirmation hearing scheduled, the president appointed him to the job while Congress was in recess. As a recess appointment, Berwick’s term was to expire Dec. 31. Earlier this year, 42 Republican senators signed a letter pledging to block his confirmation, effectively ending any chance of him serving beyond 2011.

A Harvard University-educated pediatrician, Berwick won endorsements healthcare groups for his academic work, which focused on reducing the cost of care while improving quality and patient experience. Republicans, however, seized on remarks he made praising Britain’s National Health Service as an “example” for the United States to follow. Many accused him of supporting the “rationing” of services, a claim Berwick has rejected.

“Every bone in my body, as a physician, even as a person, is to get everything [patients] want and need and to help them at every step,” he told The Washington Post in an interview this summer. “I have gone to the mat to get a last-ditch bone marrow transplant for a child with leukemia . . . and they are telling me I’m rationing? They haven’t met me.”

Quickly after Berwick’s announcement, the White House nominated Marilyn Tavenner, the principal deputy administrator for CMS, to lead the agency. As head of Medicare and Medicaid, the former nurse would be responsible for programs that already provide coverage to 100 million Americans, as well as for putting in place the new health overhaul law to cover the uninsured. She joined CMS in 2010 after serving as Virginia’s secretary of health and human resources under then-Gov. Tim Kaine, a Democrat.

Tavenner quickly received “thumbs up” from an unlike source—House Majority Leader Eric Cantor (R-Va.).

Cantor, one of Congress’ Republican stars, told the Associated Press that Tavenner is “eminently qualified” to run Medicare. Cantor is not a member of the Senate, so he does not get a vote on Tavenner’s nomination, but his views are influential with conservatives. Cantor says he met Tavenner years ago when he was a state legislator in Richmond, Va., and she was a senior executive for Hospital Corporation of America, a hospital chain.

“She was an individual with a wealth of knowledge about the complexities of the healthcare system, and she came forward with solutions that actually made sense,” Cantor told AP. “I always found her to be extremely professional and understanding of the value of the private sector in healthcare.”

Cantor said he is convinced that Tavenner is committed to preserving the role of the private sector in healthcare.

Responsibility for health coverage in the United States is close to evenly split between federal and state programs such as Medicare and Medicaid, and workplace and private insurance. Republicans charge that Obama is trying to engineer a complete takeover by government, while the president insists his way is the best approach for preserving a system of shared responsibility in the face of unsustainable cost increases and millions of uninsured.

Tavenner’s nomination has been endorsed by groups representing hospitals, doctors and the health insurance industry.