Medicare Agency Hampered By Six Years Without A CEO

FILE - In this Dec. 12, 2005 file photo, Marilyn Tavenner speaks in Richmond, Va. Medicare paid $5.6 billion to 2,600 pharmac
FILE - In this Dec. 12, 2005 file photo, Marilyn Tavenner speaks in Richmond, Va. Medicare paid $5.6 billion to 2,600 pharmacies with questionable billings, including a Kansas drugstore that submitted more than 1,000 prescriptions each for two patients in just one year, government investigators have found. The new report by the inspector general of the Health and Human Services department finds the corner drugstore is vulnerable to fraud, partly because Medicare does not require the private insurers that deliver prescription benefits to seniors to report suspicious billing patterns. (AP Photo/Steve Helber, File)

The nation's largest health insurer hasn't had a full-fledged chief executive for more than six years.

No, it's not UnitedHealth Group or WellPoint -- it's the Centers for Medicare and Medicaid Services, the massive federal agency that oversees those two entitlement programs and is in charge of carrying out the implementation of big parts of President Barack Obama's health care reform law.

Obama's current nominee, Marilyn Tavenner, has been running the Centers for Medicare and Medicaid Services in an acting capacity since the December 2011. That isn't likely to change any time soon, Politico points out. Controversies about health care reform and the dysfunctional Senate are to blame.

The result is that an agency that has a budget rivaling the Pentagon's and that provides health care coverage to more than 100 million Americans is operating without a leader who can make a mark.

Former CMS administrators say the agency runs better with a leader who has the Senate's stamp of approval, rather than someone with an "acting" administrator title. A confirmed appointee has more power to push back on Congress, the White House or other parts of the Department of Health and Human Services, they say. Anyone in an "acting" role -- but hoping for confirmation -- might worry about making waves or be hesitant about providing fodder to opponents.

The Centers for Medicare and Medicaid Services hasn't had a confirmed administrator since Mark McClellan resigned on Oct. 15, 2006, during President George W. Bush's second term. Since then, six people have served as acting administrator. Bush nominated longtime Health and Human Services official Kerry Weems to the post but the Senate never voted on him; Weems worked as acting administrator for more than a year. Likewise, Obama nominated Donald Berwick for the job but the Senate never acted, prompting Obama to install him via a recess appointment that expired at the end of 2011.

The constant threat of filibusters against presidential nominees has much more do to with the situation than the candidates' qualifications. Tavenner is a nurse, a former state health official and a veteran hospital industry executive. Berwick is a pediatrician who founded a health care nonprofit that advises hospitals and other providers how to improve quality and decrease costs. Weems worked in nonpartisan jobs at the Department of Health and Human Services for more than two decades.

Obstructing these nominations didn't use to be the norm, Politico notes.

During most of the 1980s, 1990s and early 2000s, people cycled in and out of the post with relative ease. Acting administrators served for only a few months between administrations or confirmed administrators. Even during the controversial debate over President Bill Clinton's "Hillarycare" in 1993, CMS nominee Bruce Vladeck's confirmation floated under the radar. His hearing lasted 45 minutes, and his confirmation passed the Senate unanimously, he said.