A man once berated by lawmakers for massive Obamacare failures is now leading the agency that guides its implementation.
When Marilyn Tavenner steps down from the Centers for Medicare and Medicaid Services at the end of February, former technology executive Andy Slavitt will take her place as the head honcho overseeing the Affordable Care Act’s major components. Slavitt joined CMS as second-in-command last June to help improve HealthCare.gov before year two of enrollment.
Just months earlier, he and other executives involved in helping to build the federal insurance marketplace had been hauled before a House committee to explain why it failed so badly in its first year. At the time, Slavitt was a vice president at Optum, which owns one of the contractors paid to develop the insurance marketplace.
Slavitt will take over CMS in an acting capacity at the end of the second Obamacare enrollment season, which has avoided the technological disasters that marked year one. Consumers have been able to enroll in plans with relative ease and the website has stood up under heavy traffic — a notable shift from last year’s crashes.
But that doesn’t mean his job will be easy.
The agency must keep convincing uninsured Americans to sign up for Obamacare coverage to progress toward the eventual goal of 25 million people covered. There’s a chance the Supreme Court could block the law’s insurance subsidies to poor and middle-income Americans in states relying on Healthcare.gov instead of their own marketplace, after it hears a challenge to the subsidies in March.
And then there’s the challenge of driving down overall health care costs and improving quality in Medicare, which covers 50 million Americans. The Affordable Care Act contains some experimental programs aimed at those goals, but moving the entire program in that direction is difficult.
“You can see why [Slavitt] would be a good fit because he is already leading the most critical part of the administration’s priorities for the agency now,” said Mark McClellan, former CMS administrator from 2004 to 2006. “The downside of that is that the rest of CMS is a huge job between Medicare and Medicaid.”
To top it off, the health care law remains politically divisive, making it uncertain whether the Senate would confirm Slavitt if he were to be nominated. The White House hasn’t said whether it will nominate Slavitt, or someone else, to permanently fill Tavenner’s post.
“Andy will be the acting administrator until the White House nominates, and the Senate confirms, a permanent CMS administrator,” a CMS official told the Washington Examiner.
Some say the administration might not even wade into that potential battle, as less than two years remain in the Obama presidency. Even if the president were to nominate someone, it could take that long just to get him or her confirmed. Tavenner served as acting administrator for nearly 18 months before the Senate finally approved her.
Tom Scully, who led CMS from 2001 to 2003, said it wouldn’t be “unheard of” for the administration to have an acting administrator for the final few months. The agency has been led by a confirmed administrator less than four years out of the last 10.
“[Confirmation] just gives you more moral authority with the agency,” Scully said. “Does it make a hell of a lot of difference? Probably not.”
The administration is most likely weighing whether Slavitt is able to manage CMS long term or whether he should return at some point to focusing more on the health care law, McClellan said. Former aides say Tavenner thinks highly of Slavitt, which could influence the administration’s decision.
“I think the administration is probably thinking about whether Andy should keep concentrating on what he’s been concentrating on or can he handle that and this broad range of activities as well,” McClellan said.
