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Medicare Agency Nominee Likely to Face Health Care Law Questioning

Marilyn Tavenner has another shot to be confirmed as leader of the Centers for Medicare and Medicaid Services, but getting there will require defending the 2010 health care law to Senate Republicans.

Tavenner is the acting administrator of the agency, which has not had a confirmed leader in seven years. Even though Tavenner herself is generally respected, the agency — charged with overseeing major federal health programs and implementation of the health care law (PL 111-148, PL 111-152) — comes with a lot of controversy.

A confirmation hearing will provide Senate Finance Committee Republicans with a forum to air their concerns about the health care law and to grill Tavenner about its implementation. Tavenner has been acting as Centers for Medicare and Medicaid Services (CMS) administrator since December 2011, but going through the confirmation process will put her in the hot seat.

GOP lawmakers were quick to call for a confirmation hearing following Tavenner’s nomination Thursday.

“The Senate should give Ms. Tavenner every opportunity to show she is a worthy choice to lead the agency responsible for Medicare, Medicaid, the Children’s Health Insurance Program, and a lot of the implementation of the Obama health care law,” Charles E. Grassley, R-Iowa, said in a statement.

Sean Neary, communications director for the Finance Committee, said the panel has not yet received the necessary paperwork on Tavenner’s nomination, including a completed questionnaire and tax return information. Once it does, the panel will begin the vetting process, he said.

Committee ranking Republican Orrin G. Hatch of Utah praised Tavenner as “smart and diligent,” but added that he needed more opportunity to speak with her.

“With Medicare and Medicaid on an unsustainable fiscal path, the cost of health care continuing to rise, and with the implementation of the health law moving forward, there are many questions she’ll need to fully answer before I decide whether or not to support her nomination,” Hatch said in a statement.

A spokeswoman for Grassley said the senator is likely to ask Tavenner about philosophical issues, such as the future directions of Medicare and Medicaid as well as oversight and investigation issues, including the money granted to states to promote health insurance exchanges. Other questions may cover the role of fee-for-service payment systems in Medicare, and whether Medicaid should cover people with incomes more than 133 percent of the poverty line.

The controversy over the health care law is one reason Tavenner’s predecessor, Donald M. Berwick, was never confirmed. With Berwick’s nomination facing strong GOP opposition, Senate Finance Chairman Max Baucus, D-Mont., never scheduled a confirmation hearing. President Barack Obama gave Berwick a recess appointment in July 2010.

Many Republicans, especially Sen. Pat Roberts, R-Kan., vocally objected to Berwick’s nomination. Berwick’s work on comparative effectiveness research, combined with his praise of the British health care system, led to Republicans’ concerns that he would promote rationing of care.

Senate Republicans used Berwick’s nomination to criticize Obama’s health care philosophy.

During a May 2010 Senate floor colloquy with John Barrasso, R-Wyo., and Senate Minority Leader Mitch McConnell, R-Ky., Roberts said Berwick was “the wrong man, wrong time, wrong job.”

“Dr. Berwick is the perfect nominee for a president whose aim has always been to save money by rationing health care,” Roberts said.

After Berwick’s recess appointment, Republicans continued to grill him on the law’s implementation and his views on health care whenever he appeared at committee hearings. As Berwick’s appointment came to an end in December 2011, Obama nominated Tavenner to replace him. The Senate, however, never considered her nomination, and she has remained in the acting position since then.

Tavenner is almost certain to face the same scrutiny given to Berwick. But she also has the support of several health care groups, who responded to her nomination with calls for a quick confirmation process.

“We commend the White House for recognizing that Ms. Tavenner is a qualified and exemplary leader in health care, and encourage the Senate to move forward on her confirmation quickly,” said Mark Parkinson, president and CEO of the American Health Care Association and the National Center for Assisted Living. “The CMS Administrator is too important a position to leave open, and Ms. Tavenner is the right leader for the job.”

John Reichard contributed to this story.

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