The Surgeon General Is Confirmed!


We had been asking for weeks now, why don't we have a Surgeon General? Rachel Maddow started up the quest again on her show on Monday night, October 26, and Dr. Nancy Snyderman of MSNBC continued it on her show Thursday October 29th. Apparently, some of the public attention turned the tide.

The answers to the delay have been varied, contradictory, and byzantine. Apparently it was not because of Dr. Regina Benjamin herself, say the Republicans. They think she's qualified and some have raved about her. And she is, indeed, an amazingly qualified family physician who practices in rural Alabama.

So what were the reasons? If I had a lifetime, I probably could not explain that exactly, but I"ll give it a try. (Harry Reid said it well in a post that Ezra Klein did today.)

Initially, the story was that Senator Mike Enzi of Wyoming and seven Republican colleagues (McConnell, Kyl, Grassley, Cornyn, Alexander, Murkowski and Thune), had written a letter on September 24th stating that they would not support ANY of the nominees for health positions, including Dr. Benjamin, until certain issues were resolved with HHS and CMS. So the Republicans set up a procedural delay on the Surgeon General nomination that effectively kept the vote from coming to the floor of the Senate.

This was done despite the fact that Dr. Benjamin received a unanimous vote of approval from the Senate HELP committee -- from both Republicans and Democrats -- when she was vetted by them earlier in September. So what changed?

What changed was that Medicare had issued a "letter of warning" or whatever you want to call it, to health insurance companies including Humana, regarding communications they had been sending their Medicare beneficiaries about "possible" changes to the Medicare Advantage program. Medicare routinely regulates what health plans can tell members about their benefits. That is not new.

Dawn Teo in a prior Huffington Post piece, explained this kerfuffle in detail.

According to a source with inside knowledge of the way CMS regulates marketing guidelines, Medicare providers are only allowed to communicate with plan members about the benefits they have now, not about possible changes to benefits. They are also not allowed to use plan-related communications to lobby for policies or legislation.

This seemed to be the essence of the dispute that was holding up the Surgeon General's nomination and many others -- what can the government tell health plans about their communications with members? The action by HHS enraged Humana, headquartered in Kentucky and supporter of Senator Mitch McConnell and other Senators as well. After some back and forth in the last month to which I am not privy, HHS apparently backed off and has ended up only requiring that Medicare beneficiaries be allowed to "opt out" of receiving these communications.

Did that solve the problem? It did not and it has not. The Republican Senators who sent the letter then declared that the issue was bigger than this -- it was an issue of freedom of speech, constitutionality, etc. that all companies be allowed to communicate freely with their members about things that might happen as a result of legislation that hasn't happened yet.

Are you with me so far?

In conversations with staffers of Senators Enzi, McConnell and Reid in the past few days, I have learned that there has been a lot of finger pointing going on, the procedural issues are truly complicated, that there was NO "secret hold" on the nomination as had been charged -- it was pretty public by this week -- but the bottom line is that the Humana "thing" is still an issue, and therefore the Republicans will not lift their delaying tactics on the other nominees who are awaiting confirmation until the issue is resolved to their satisfaction.

That means that while Dr. Benjamin has been confirmed, some of the other nominees for HHS positions will remain in limbo while this fight plays out. When I asked the Republican staffers why they couldn't resolve this problem outside of the nomination process -- that is, figure out another way to do it other than holding nominees hostage, they had no specific answer.

On the MSNBC Nancy Snyderman show this past week, I had 2 minutes to try to explain this and the best I could do was to say it's "complicated". And complicated it is. But for the average person, it remains puzzling and irritating that at a time when we needed the voice of our nation's doctor, the Surgeon General, explaining flu vaccine, shortages, protection measures, etc., we did not have a Surgeon General to deliver that message until Friday the 30th of October.

When Senator Harry Reid asked the Senate for "unanimous consent" to proceed with Dr. Benjamin's confirmation vote on Thursday night the 29th, there was not a single objection from any of the 100 Senators. She was confirmed by a voice vote.

The other nominees are still waiting.

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