Even if President Obama prevails in the fight for his health law, implementing it in a smooth, timely manner will be another challenge. The Centers for Medicare & Medicaid Services is charged with making the health law work, drafting regulation, setting up new programs and providing oversight. But for years Congress has hobbled the agency. For instance, the Senate hasn’t confirmed a full-time CMS administrator since 2006. In the agency’s 35 years, the average tenure for the position is 14 months. CMS has had a staff of about 4,900 since the Carter administration despite the increasing number of Medicare and Medicaid beneficiaries it serves and its full plate of responsibilities. According to a 2000 study by the U.S. General Accounting Office, the turnover at the top has “inhibited the implementation of long-term Medicare initiatives for the pursuit of a consistent management strategy.”

Read the story.