CQ: Tavenner is the boss of CMS—with or without confirmation

Acting administrator ran CMS operations before and after ACA passage

The Senate may never officially confirm CMS Acting Administrator Marilyn Tavenner, but that will not stop her from effectively running the agency and implementing the federal health reform law, according to CQ HealthBeat.

Earlier this week, Senate Democrats revealed that they had no plans to schedule confirmation hearings for Tavenner. According to Senate Finance Committee Chair Max Baucus (D-Mont.), it is "virtually impossible" to see how Tavenner could win the support of 60 senators, given Republicans' possible effort to block Tavenner's nomination and her role in health reform implementation.

However, Tavenner managed the operations of CMS before and after the passage of the Affordable Care Act—first as the agency's principal deputy administrator and now as its acting administrator. Observers say that operational control of the agency does not depend on her confirmation.

"From an operations perspective, she is running the place beautifully," says Dan Mendelson, who served as President Clinton's health budget chief. Mendelson adds that "Regulations are getting done with drama, consultation is happening with the private sector, and the staff see her as the person in charge… [W]hile it's deplorable that a straight shooting centrists can't get confirmed, I don't see it holding her back."

However, former CMS Administrator Gail Wilensky says that a permanent leader allows CMS to be more aggressive in its decision-making. CMS has not had a confirmed administrator since 2006 (Reichard, CQ HealthBeat, 5/23 [subscription required]).

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