Already Angling for Berwick’s Replacement

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The New York Times reports today that some members of Congress have offered an early seal of approval to a health care administrator who could succeed Medicare/Medicaid chief Don Berwick. According to the Times, Berwick’s deputy Marliyn Tavenner has emerged as a leading candidate to fill the post before or once Berwick recess appointment expires at the end of this year.

It was always a long shot that Berwick would be able to stay in the job – overseeing a $700 billion-plus budget and implementation of much of the Affordable Care Act – long-term. I was among those surprised back in January when the Obama Administration decided to formally nominate him for the post a third time, given the smaller Democratic Senate majority in place after the 2010 midterm elections. In order to confirm Berwick, the Administration would have needed the votes of at least seven GOP senators, provided every Democratic senator fell in line. Last week, 42 Republican senators signed a letter opposing Berwick’s nomination and sealing his fate as a lost cause.

Still, if he holds on until the end of this year, Berwick will have been at the helm of the Centers for Medicare & Medicaid Services (CMS) for 17 months. This is a substantial period of time and long enough to have set a tone at CMS and to have recruited key second and third-tier administrators to work on important pieces of the Affordable Care Act. Berwick has already jump-started the Center for Medicare and Medicaid Innovation, the best hope health reformers have for finding smart ways to cut health care spending. Under Berwick’s tenure, the federal regulation of private insurance was also brought under the CMS mantle, a power consolidation that could have long-range implications.

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