Bipartisanship was never in the cards when it came to putting the health care overhaul law in place -- but the White House announcement Tuesday evening that it would bypass Congress and install Donald M. Berwick as administrator of the Centers for Medicare and Medicaid Services without Senate approval means his every appearance on Capitol Hill will present a fresh opportunity for Republicans to portray the law and its implementation to the American people as an act of naked partisanship.
President Obama is expected to put Berwick in place Wednesday by announcing a "recess appointment." The tactic allows nominees to be put in office without Senate confirmation during the absence of lawmakers from Capitol Hill but the appointment expires at the end of the following calendar year.
Republicans jumped Tuesday night at the chance of making Berwick, renowned in health policy and health industry circles as a quality improvement guru, the new poster child for Democratic partisanship.
Sen. John Barrasso of Wyoming, who has led GOP efforts to disparage Berwick's nomination, issued a statement accusing the Obama administration of "an insult to the American people."
"Dr. Berwick is a self professed supporter of rationing health care," Barrasso said. "And he won't even have to explain his views to the American people in a congressional hearing."
Obama's decision to move forward on Berwick without Senate approval is an act of arrogance and sneakiness that puts seniors in jeopardy, said Senate Minority Leader Mitch McConnell, R-Ky.
That "this administration won't allow the man charged with implementing the president's plan to cut $500 billion out of Medicare to testify about his plans for the care of our nation's seniors is truly outrageous," McConnell said.
"As if shoving a trillion-dollar government takeover of health care down the throat of a disapproving American public wasn't enough, apparently the Obama administration intends to arrogantly circumvent the American people yet again by recess appointing one of the most prominent advocates of rationed health care to implement their national plan," McConnell said.
Berwick is widely respected for programs to reduce medical errors, and efforts to portray him as an advocate of rationing of medically necessary care don't wash in health policy and industry circles. Nor do they ring true with Republicans who have run the Medicare and Medicaid programs. Past GOP administrators of the programs such as Gail Wilensky, Tom Scully, and Mark McClellan have praised Berwick as a solid choice to head CMS.
But the White House may have frittered away some of the good will Berwick enjoys on the Republican side by making the recess appointment.
Wilensky said the move was ill timed and hasty and that using this process will "forever taint his appointment."
"You've got people unhappy as it is, somewhat because of his statements, a lot because of anger and frustration with the legislation and the way it proceeded, and now this," Wilensky said. "Any time he's speaking before Congress it will be more difficult."
Wilensky said she understood Obama's interest in having someone at the helm of CMS at such a pivotal time, but said the administration had delayed announcing the nomination for months. Berwick had first been approached by the administration, she said, very early in 2009. Obama announced his nomination in April, soon after the health care law was signed.
"It may have been that this ultimately is necessary," Wilensky said. "But I would have waited a few more months to see if they couldn't get it through regular process before resorting to this. I don't have objection to resorting to this process if there really is no other way, but they only made the freaking announcement a couple of months ago. It was way premature to pull this."
The White House announcement that it will name Berwick to the slot comes just as the health care overhaul law has been gaining popularity in public opinion polling. The Kaiser Family Foundation announced last week that those regarding the law favorably climbed from 41 percent to 48 percent in the past month.
For the White House, the decision to move ahead was a gamble that the benefit of putting an energetic appointee in charge of CMS after months of having a leaderless agency outweighed the negative fallout of the recess appointment. Regardless of Berwick's route to office, he was destined to be a lightning rod for critics who depict him as a threat to senior care, White House officials said.
"Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points," White House Communications Director Dan Pfeiffer said in a blog posting on the White House site Tuesday evening.
With many important provisions of the law to implement, the process could not wait any longer, Pfeiffer suggested.
"His deep firsthand knowledge of our health care system makes him the right administrator to tackle the law's requirements, particularly that CMS improve nursing home care, reduce unnecessary hospital re-admissions, and expand coverage to millions of Americans who need it most."
But without a Senate vote confirming the nomination, Berwick's appointment expires at the end of 2011, creating an opportunity at the end of next year for Republicans to launch a fresh round of attacks on Berwick if Democrats try to extend his tenure or to use the nomination of any successor to attack the law anew.
Source Citation
"Berwick 'Recess' Appointment: Gift to GOP That Keeps on Giving." CQ Healthbeat 7 July 2010. General OneFile. Web. 9 Nov. 2010.
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