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On the Third Hand: Agency chiefs

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Rep. Michael Burgess, R-Texas, a medical doctor on the U.S. House Energy & Commerce Committee, said recently during a hearing on the state-based exchanges that Republicans do actually want to make Patient Protection and Affordable Care Act (PPACA) programs and rules work better, as long as PPACA is still law.

Andrew Slavitt, the acting administrator at the Centers for Medicare & Medicaid Services (CMS), went on to say reasonably interesting things about the PPACA exchange system in a reasonably interesting way, in spite of the cat-and-mouse game between the Obama administration and congressional Republicans that seems to require administration hearing witnesses to put their ability to think independently in a blind trust.

Even when Slavitt declined to say anything (about, say, what’s going on with the Health Republic Insurance of New York checks to doctors), he declined to say anything about those topics in what seemed to be a refreshingly meaningful way.

But what was immediately obvious about the hearing is that, as sincere as Burgess seemed to be about his own commitment to making any health care law that exists work as well possible, Slavitt is an acting CMS administrator, with not clear path to becoming a confirmed administrator.

Slavitt succeeded Marilyn Tavenner as the head of CMS in the summer. It seems as if he’s still “acting” because, ever since the Democrats tried to get Clarence Thomas, Democrats and Republicans have been engaging in an ever-escalating war to keep the other party’s nominees from getting through the Senate.

On the one hand, maybe that makes sense for Supreme Court nominees, who are in office for life.

The secretary of the U.S. Department of Health and Human Services (HHS) is a member of the cabinet, and in a long line to succeed the president. Maybe it makes sense for Congress to get ferociously partisan about HHS secretary nominees. 

See also: President Romney’s cabinet: Who would he choose?

On the other hand, it seems to make no sense for Congress to keep agency heads in limbo. Acting agency heads can’t become president through an automatic succession process, unless something goes so drastically wrong that questions about the succession process will be the least of our problems. Acting agency heads can, apparently, do most of what a confirmed head would do, but simply face peer pressure not to rock boats. They aren’t in office for life. They can be, and do get, fired. 

They may administer programs and rules that infuriate the opposing party, but they also generally administer programs and rules that most Americans support.

Acting CMS Administrator Andy Slavitt is charge of the Medicaid nursing home benefits for people’s genuinely impoverished, genuinely incapacitated parents. He’s in charge of what Medicare does about Ebola. He’s involved with trying to persuade doctors to keep treating Medicaid patients.

On what planet does it make sense for CMS to have to make do with a chief who feels pressure to just sit quietly in his office and not get in trouble?

On the third hand, if Slavitt were confirmed by the Senate, maybe he would do so something Republicans hate.

So, here’s an idea for an agency official appointment process reform: If senators in a party happen to hate a presidential nominee, that’s fine. They can block the nominee. But then they have to provide a list of 10 nominees they can live with who are acceptable to the Senate and House minority leaders.

That way, opposition parties could still shut out nominees that they loathe, but federal agencies could have chiefs who feel as if they can commit to making the government work as well as it can work, under the circumstances, not just temps who may be inclined to clock in at 9 a.m., clock out at 5 p.m., and binge watch their shows the rest of the time.

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