KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Obama Uses Recess Appointment To Install Berwick As Head Of Medicare, Medicaid

Bloomberg Businessweek: "President Barack Obama bypassed the U.S. Senate and appointed Donald Berwick as administrator of the Centers for Medicare and Medicaid Services. ... Obama put Berwick in the job today using a recess appointment, a procedure that lets the president fill positions without Senate confirmation when Congress isn't meeting. Lawmakers are on a week-long break for the Independence Day holiday" (Johnston, 7/6).

CQ: "As 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 Boston Globe Political Intelligence Blog: "Key Democrats on the Senate Finance Committee were divided in their reaction to President Obama's recess appointment this morning of health care policy guru Dr. Donald Berwick. ... For the Obama administration, the maneuver around the legislative branch's usual confirmation process was driven by political necessity. … Despite those tactical considerations, an objection came from the chairman of the Senate Finance Committee, Democrat Max Baucus of Montana, an Obama ally who would have led Berwick's confirmation hearings." [Meanwhile], "John F. Kerry of Massachusetts, a member of the Senate Finance Committee, diverged from that point of view. He strongly defended the White House circumvention of the legislative branch in this instance" (Rowland, 7/7).

CBS News: Liberal and conservative reaction has been swift to the formal announcement ofth erecess appointment. The debate over the White House's action "makes clear what the White House knew all too well -- Berwick may not have survived the Senate confirmation process, which would have turned into a proxy debate over health care reform" (Hendin, 7/7).

Politico: In a statement, President Obama said "It's unfortunate that at a time when our nation is facing enormous challenges, many in Congress have decided to delay critical nominations for political purposes." But in a statement of his own, 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" (Phillip, 7/7).

The Boston Globe, in an earlier article: "The recess appointment... means Obama won't have to subject his nominee to promised Republican grilling of Berwick in nomination hearings, because appointments made during official congressional breaks do not require a vote. The agency has not had a permanent director since 2006." Berwick would have faced tough questioning from Republicans on a number of controversial statements, including those expressing admiration for the British health system and on rationing health care.

The White House said that Republicans wanted only to stall the nomination to score political points. "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." Republicans, however, seized on the opportunity to attack the appointment and Berwick. "'This recess appointment is an insult to the American people,' Senator John Barrasso, a Wyoming Republican, said. 'Dr. Berwick is a self-professed supporter of rationing health care, and he won't even have to explain his views to the American people in a hearing. Once again, President Obama has made a mockery of his pledge to be accountable and transparent'" (Milligan, 7/7).

Roll Call: "Senate Minority Leader Mitch McConnell (R-Ky.) and Republican Sens. Bob Bennett (Utah) and Pat Roberts (Kan.) attacked Berwick's record during a colloquy on the floor in May, and 56 House Republicans wrote to Obama last month to ask him to withdraw the nomination over Berwick's support of comparative effectiveness research" (Starkey, 7/6).

Kaiser Health News has a resource guide on Berwick with a biography, collection of media profiles and a video interview (7/7).

The New York Times: "In two decades as a professor of health policy and as a prolific writer, Dr. Berwick has championed the interests of patients and consumers. At the same time, he has spoken of the need to ration health care and cap spending, has supported efforts to 'reduce the total supply of high-technology medical and surgical care' and has expressed great admiration for the British health care system. Under the new law, Medicare will be a testing ground for many innovations that reward high-quality care and penalize providers of poor care. The law will expand Medicaid to cover 16 million more people with low incomes" (Pear, 7/6).

Los Angeles Times: The new health law "strives to make Medicare more efficient as well as dramatically expand Medicaid, the joint state-federal insurance program for the poor. Approximately 47 million people are enrolled in Medicare, and 58 million people are enrolled in Medicaid. 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).

The Wall Street Journal: The position will be one of the most instrumental positions in implementing health reform because it will eventually oversee the placement of millions more in Medicaid and "it will cut more than $400 billion over a decade in Medicare payments to health-care providers" (Adamy, 7/7).

Politico, in an earlier article: "CMS has not had a permanent head for four years now, a point that [White House spokesman Dan] Pfeiffer used in explaining the White House's decision to appoint Berwick with the Senate out of session for the July Fourth recess. The Democratic-controlled Senate never took up the nomination of Kerry Weems, former President George W. Bush's choice in 2007 to head the agency, and the CMS has cycled through a series of acting administrators who do not need Senate confirmation" Berwick has attracted the support from medical societies and trade groups including the American Medical Association, the leading doctor group (Kliff and Haberkorn, 7/7).

The White House website has the announcement.

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