Slavitt's CMS Confirmation Could Face Opposition

The nomination of Andy Slavitt to administrator of the Centers for Medicare & Medicaid Services is raising concerns about potential conflicts of interest between the acting administrator and a former employer.

Another contentious Senate confirmation hearing may be in the works over the new leadership at the Centers for Medicare & Medicaid Services.

Senate Republicans have signaled that they may challenge the Obama Administration's nomination Thursday of Andy Slavitt to be administrator at CMS. Slavitt has been with CMS for a year, and has served as acting administrator since February, when Marilyn Tavenner resigned from the job she'd held for 21 months.

Senate Majority Leader Mitch McConnell last week issued a statement that suggesting that Slavitt's nomination is not a done deal, although the Kentucky senator's ire seemed directed at the Patient Protection and Affordable Care Act more than at Slavitt.

"The head of the agency that oversees Medicare and Medicaid should be focused on what the American people expect him to do: administer these important programs, not allow his attention to be diverted instead to the implementation of some gigantic, unworkable health care law that hurts hardworking Americans," McConnell said.

"While Andy Slavitt's nomination will receive thorough consideration in the Senate, it has long been clear that no one can successfully manage a law as unworkable as Obamacare. The sole focus of CMS should be to look out for our nation's seniors and the many vulnerable Americans who use these programs, without the distraction of Obamacare."

Earlier this year, Senate Finance Committee Chairman Orrin Hatch, (R-UT), and Judiciary Chairman Chuck Grassley, (R-IA), raised concerns about potential conflicts of interest between Slavitt and his former employer, Optum.

In a March 31 letter to Health and Human Services Secretary Sylvia M. Burwell, the senators noted that Optum is a subsidiary of UnitedHealth Group, and that it was subcontracted with another UnitedHealth subsidiary, QSSI, to administer the bungled rollout of HealthCare.gov.

Slavitt led a team of troubleshooters to repair the website after the failed launch.  

"The multiple relationships between Mr. Slavitt and United subsidiaries raise real concerns about how, and to what extent, CMS has prevented conflicts of interest given the fact CMS makes decisions that impact United and its subsidiaries every day," the two chairmen wrote. "While Mr. Slavitt may have recused himself from such decisions in the past, it may be difficult or impossible for him to do so in his current position at CMS."

A History of Contention
If Slavitt's nomination is challenged by Senate Republicans, it won't be the first time that the top CMS post has been a source of contention for the Obama Administration, or for the Bush administration before him.

President Obama in May, 2010, nominated Donald Berwick, MD, to lead CMS. When the Senate failed to act to confirm him, Obama made a recess appointment. Berwick resigned in November 2011 after Senate Republicans vowed to block his nomination.  

In sharp contrast, Tavenner's confirmation hearing was almost a love fest. The Senate overwhelming approved her nomination in May, 2012.

Tavenner was the first CMS administrator to gain congressional approval since 2004, when Mark McClellan, nominated by President George W. Bush, was confirmed.

Healthcare Sector Applauds
Leading associations within the healthcare sector have voiced their support for Slavitt.

Rich Umbdenstock, president and CEO of the American Hospital Association, in a statement released Friday, said Slavitt "has a deep understanding of the U.S. health care system and a commitment to improving patient care. We believe Andy's proven leadership in the public and private sectors speaks to the ongoing contributions he will make at CMS."

Bruce Siegel, MD, president and CEO of America's Essential Hospitals, in remarks released by his office Friday, called for a quick confirmation hearing. "[Slavitt] brings the experience and leadership needed to effectively manage the complex programs on which our nation's vulnerable people and their hospitals depend," Siegel said.

Ron Pollack, executive director of Families USA, in a media statement, called Slavitt a "superlative" choice.

"Mr. Slavitt has played a remarkably successful role in overseeing the second open enrollment period under the Affordable Care Act and played a heroic role in the successful re-launch of HealthCare.gov," Pollack says. "His actions as Principal Deputy Administrator for CMS have consistently been sensitive and responsive to the needs of healthcare consumers."

The Workgroup for Electronic Data Interchange, a nonprofit that works to enhance the exchange of healthcare information, is "generally speaking… supportive" of Slavitt's nomination, says Devin Jopp, CEO of WEDI and an advisor to the Secretary of Health and Human Services. "We believe his demonstrated leadership and background will be a good fit in his new role as CMS administrator."