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.
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.