This week, Congress was in recess, for the Fourth of July. So President Barack Obama’s decision to bypass the Senate and appoint Dr. Donald Berwick head of the Centers for Medicare and Medicaid Services — an agency that has not had a permanent administrator since 2006 — completely dominated health policy news coverage.
The Boston Globe reported on Berwick’s qualifications: “Berwick is a Harvard Medical School professor and president of the Institute for Health Care Improvement. He is widely respected by veteran policy officials across the political spectrum, analysts largely agree.” The Globe detailed the motivation behind the recess appointment: “Obama won’t have to subject his nominee to promised Republican grilling” in hearings where he would have faced tough questions about his public positions, including those expressing admiration for the British health system and on rationing health care (Milligan, 7/7). KHN provided a resource guide detailing his background, a collection of his speeches and writings and related news coverage (7/8), as well as a transcript of his now-controversial speech to the British National Health Service.
Bloomberg Businessweek described the recess appointment as “a procedure that lets the president fill positions without Senate confirmation when Congress isn’t meeting” (Johnston, 7/6). CQ filled in more of details: “[A]s a recess appointee, Berwick will have all the authority of someone confirmed by the Senate. But under the Constitution, his appointment will expire at the end of the next session of Congress, in late 2011” (CQ staff, 7/7).
The reaction from congressional Republicans was swift. According to The Hill, the appointment “reignited the debate over healthcare” and gave the GOP a chance “to rehash the ideological differences between the parties” (Lillis, 7/7). The Wall Street Journal’s Washington Wire quoted Senate Minority Leader Mitch McConnell, R-Ky.,: “Truly outrageous” and Sen. Mike Enzi, R-Wyo., tagged it “[o]ne more example of the administration’s unwise approach to reforming health care” (Adamy, 7/7).
Gail Wilensky, a former administrator of the Medicare and Medicaid programs under President George H.W. Bush, told CongressDaily: “There is just nothing good about having it happen this way. His tenure will be more complicated and acrimonious” (McCarthy, 7/7).
Politico reported that even some Democrats had qualms. “Sen. Max Baucus, D-Mont., … said he was ‘troubled’ that Obama chose to install Berwick without a formal confirmation process. ‘Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee – and answered,’ Baucus said.” He added, though, that he looked forward to working with CMS “as they implement health reform to deliver the better health care outcomes and lower costs for patients we fought to pass in the landmark health reform law” (Phillip, 7/7).
The Christian Science Monitor offered some historical perspective. “The increased presidential use of recess appointments bears a direct correlation to political polarization in Congress and willingness of the minority party to filibuster to delay or deny confirmations, says Thomas Mann, a senior fellow at the Brookings Institute. … As president, George W. Bush made 171 recess appointments, and Bill Clinton 139” (Parti, 7/7).
Much of the reaction surrounding Obama’s step was about CMS’ important role implementing the new health law. According to The Wall Street Journal, Berwick will be “instrumental” because the agency will eventually oversee the enrollment of millions more people in Medicaid and “it will cut more than $400 billion over a decade in Medicare payments to health-care providers” (Adamy, 7/7). USA Today also notes that, although “the agency is little known outside the medical industry it controls an annual budget of more than $800 billion and oversees two health programs – Medicare for seniors and Medicaid for the poor – with more than 90 million enrollees” (Fritze, 7/8). Additionally, the Los Angeles Times reported that Berwick, 63, is “a leading advocate of expanding research into the comparative effectiveness of various medical treatments, a major focus of the new healthcare law that many experts think is crucial to improve the quality of care that Americans receive and cut waste in the system” (Levey, 7/7).