Tavenner Confirmed as CMS Administrator

Marilyn Tavenner, a former nurse, hospital executive, and state health official, is the first Centers for Medicare & Medicaid Services head to gain congressional approval since 2004. The full Senate confirmed her nomination with a 91-7 vote.

Marilyn Tavenner is no longer the acting administrator of the Centers for Medicare & Medicaid Services. On Wednesday the full Senate confirmed Tavenner as the administrator in an overwhelming 91-7 vote. Seven Republicans, including Senate Minority Leader Mitch McConnell (R-KY), voted against the nomination although no one spoke in opposition.

Tavenner is the first CMS head to gain congressional approval since 2004 when Mark McClellan, nominated by then-president George W. Bush, was confirmed.

Sen. Tim Kaine (D-VA) introduced the Tavenner nomination to the full Senate. Noting that she served as his secretary of health and human services when he was the governor of Virginia, Kaine asked his fellow senators to support the nomination.

"If you care about patients, then Marilyn is your person. Through all of her work, whether as a nurse or hospital administrator or a regional healthcare executive or cabinet secretary or CMS administrator has never forgotten that it is fundamentally about patients." Kaine added, "she's an expert at finding healthcare cost savings."

Before assuming the role of HHS secretary in Virginia, Tavenner worked for more than two decades as a nurse and as an executive at the Hospital Corporation of America (HCA).

Orrin Hatch (R-UT) a ranking member of the Senate Finance Committee, also praised Tavenner's "willingness to work with both parties." Noting that she has been the acting administrator since Dec. 2011, Hatch observed that "she has the ability to be a real leader; she has already exemplified that." Still, he cautioned that the CMS administrator is not a job for the faint of heart. "I will be keeping a close eye."

For a time there was concern that Tavenner's nomination might meet the same fate as that of her predecessor, acting administrator Don Berwick, MD. His nomination to head CMS was derailed by members of Congress who were stinging from the passage of the Patient Protection and Affordable Care Act. PresidentObama's decision to name Berwick to the CMS post during a Congressional recess further exacerbated the alienation.

Tavennerjoined CMS in 2010 as principal deputy administrator. In December 2011 she was named acting administrator following Berwick's resignation. Months later Sen. Max Baucus (D-MT) declined to schedule a nomination hearing with the Senate Finance Committee over concern that Tavenner couldn't attract the required 60 votes in the full Senate.

But what a difference a year makes. With President Obama re-elected and a new Congress in place, Tavenner's nomination was heard by the Senate Finance Committee in April. She received unanimous voice approval. It helped that she had the support of fellow Virginian, Rep. Eric Cantor (R-VA) who described Tavenner as "eminently qualified. If there is anyone that I trust to try to navigate [CMS] challenges, it is Marilyn Tavenner." Although he couldn't vote in the hearing, Cantor's appearance was widely considered as a signal to Senate Republicans that Tavenner was to be confirmed.

Long-time friend Tom Scully, who headed CMS from 2001 to 2004, isn't surprised by the broad Tavenner support on both sides of the aisle. "She's done a good job. She responded to requests and concerns. She personally defanged the opposition. They may not like Obama or his healthcare policy, but they like her," Scully told HealthLeaders Media in a telephone interview Wednesday.

The only blip in the process came in late April when Sen. Tom Harkin (D-IA) placed a hold on Tavenner's nomination in response to a White House plan to strip $332 million in funding from the prevention and public health fund and redirect the money to other aspects of the PPACA.

Harkin withdrew the hold in early May. In a speech before the Senate, he stated that the "White House has made it clear that it will not reverse its course with regard to its raid on the prevention fund…I believe Ms. Tavenner is strongly qualified to be the next CMA administrator…"

In his final comments before the Senate vote, Sen. Max Baucus (D-MT) noted that CMS has operated without a confirmed administrator for several years. "We need a confirmed administrator at CMS to properly implement the important programs we created in the Affordable Care Act…In just a few months, the healthcare marketplaces will be open for enrollment, and tax credits and subsidies will be available to help families and small businesses pay for healthcare. This is a critical time to have someone with Ms. Tavenner's experience confirmed and in charge at CMS. As administrator, she will have to make sure these programs are ready to go on day one. She will need to ensure the healthcare law's programs work for the people they are intended to serve. I believe she can, and I believe she will."