President Delays Nomination for Crucial Post

Published October 13, 2009

Nine months into his term, President Barack Obama has yet to nominate anyone to lead the nation’s primary health care agency, the Centers for Medicare and Medicaid Services (CMS).

The agency provides health services to more than 98 million Americans and has an annual budget of more than $700 billion.

“Certainly, it is perplexing that they have not found anybody for one of the most important health care agencies in the government,” said James Capretta, a health care policy fellow at the Ethics and Public Policy Center in Washington, DC. “And it does not give one confidence that handing over a lot more power in health care to the federal government is going to lead to stable and steady leadership.”

Avoiding Embarrassment

Diana Furchtgott-Roth, a senior fellow at the Hudson Institute, believes Obama is “probably somewhat embarrassed” about taking so long to fill the position.

“I do not think [the lack of a CMS nominee] has anything to do with him intending to cut the Medicare budget. Many people would love this position, but making political appointments to a position like this is very difficult, because you have to go through somebody’s background, go through every [potential] embarrassment of prospective candidates,” Furchtgott-Roth said. “And President Obama needs to find someone like McClellan, too—someone who has a unique blend of qualifications, someone who has been both a physician and has managerial expertise.”

McClellan, who served as CMS head from 2004 to 2006, was supposed to be replaced by budget expert Kerry Weems, who was nominated by President George W. Bush in May 2007. But the Democratic majority in the U.S. Senate declined to confirm Weems, and the position has remained vacant.

Cutting Medicare

Mark V. Pauly, a professor of health care policy at the University of Pennsylvania’s Wharton School of Business, says Obama’s desire to cut the Medicare budget is precisely why he has not nominated someone to head CMS.

The health care overhaul proposals under consideration in Congress call for Medicare cuts of more than $120 billion over the next decade and could end the popular privatized version of Medicare known as Medicare Advantage, used by more than 10 million seniors.

“A lot of what will be needed is going to have to come out of the Medicare budget, and it just may be better to arrange a health care reform deal with nobody in place at CMS to act as that staunch defender of the agency,” Pauly said.

Thomas Cheplick ([email protected]) writes from Massachusetts.