Medicare focus for next HHS head

Departure of Thompson opens way for Bush to re-energize department

December 04, 2004|By David L. Greene and Michael Stroh | David L. Greene and Michael Stroh,SUN NATIONAL STAFF

WASHINGTON - The resignation yesterday of Health and Human Services Secretary Tommy G. Thompson gives President Bush an opportunity to pump fresh energy into an agency bracing for budget cuts and a bruising political battle over how to promote a Medicare drug benefit.

The next stage of Medicare reform looms as a major agenda item confronting the next leader of the sprawling department.

That's one reason Dr. Mark McClellan, the current head of the agency that runs Medicare and Medicaid, is most often mentioned as the leading candidate to succeed Thompson.

Health policy analysts describe McClellan, a politically connected Texan whose brother, Scott McClellan, is the White House press secretary, as an official who combines medical knowledge and management skills with an easy personality that wins him friends on both sides of the aisle.

"McClellan is politically skillful, but ultimately, seems fairly wonkish and a guy who wants to make the trains run on time," said Robert Hayes, president of the Medicare Rights Center, a consumer advocacy group. "There could be more important issues for this department, but none will be more politically potent than Medicare. And he has lived and sweated trying to deal with this legislation."

Likely issues

Gail Wilensky, who directed the Medicare and Medicaid programs in the administration of Bush's father, predicted that the second term at the department would be driven less by new ideas and crafting legislation and more on the nuts and bolts of implementing reforms already signed into law.

"HHS is such a difficult department to administer in general, because it is so mammoth, covers so many areas and involves so much money," Wilensky said. "And now, so much of the focus will be on administering change that has been passed into law. Right now you want to bring in a good administrator."

End of increases?

Meanwhile, some analysts predict that as deficit hawks in Congress begin searching for ways to trim the nation's ballooning deficit, they will zero in on programs like Medicare and Medicaid and likely end a period of funding increases at the National Institutes of Health.

John D. Gearhart, a prominent stem cell researcher at the Johns Hopkins School of Medicine, said he hopes the next secretary will be a champion of the NIH, calling that agency the "engine" driving biomedical research in the United States.

"We're seeing really good people whose grants aren't getting renewed because there's not enough money," said Gearhart, whose research is NIH-funded.

NIH's budget doubled from 1998 to 2003. But next fiscal year Congress approved a meager 2.1 percent bump, to $28.4 billion. Experts say it's the smallest percentage increase for the NIH in more than 15 years.

White House officials refused to speculate about Thompson's successor.

In addition to McClellan, Thompson mentioned others yesterday who might be candidates for his job.

He included Newt Gingrich, former speaker of the House of Representatives; Dr. Elias Zerhouni, the NIH director and a former administrator at the Johns Hopkins University; and Claude Allen, a deputy secretary of health and human services from Virginia whose nomination by Bush to a federal judgeship has been stalled for more than a year by Maryland's senators, who want the seat to be filled by a Marylander.

Look at private sector

Thompson, who said he plans to look for opportunities in the private sector, became the eighth member of Bush's 15-person Cabinet to step down.

The former governor of Wisconsin guided his department's response to the Sept. 11, 2001, attacks and the anthrax scare that year.

He was involved in Bush's decision to withhold federal funding for most embryonic stem cell research, and his department also came under fire recently when the government had to announce a shortage of flu vaccines.

Announcing his resignation at a news conference, Thompson said his crowning achievement was tackling the "third rail" of politics and winning congressional approval last year of legislation to overhaul Medicare, the health insurance program for older and disabled Americans.

The mammoth Medicare bill includes a prescription drug benefit that begins in 2006 and is projected to cost taxpayers more than $530 billion over the next decade.

The administration's effort to fulfill Bush's campaign pledge for a Medicare drug benefit stalled in Congress for months, as Democrats complained that the White House was handing too much control to private insurance and drug companies and conservatives warned about the skyrocketing cost of the reforms.

In the end, a bill passed narrowly in a compromise that pleased neither side, but which the administration has staunchly defended.

A survey by the Kaiser Family Foundation and the Harvard School of Public Health last summer found that 47 percent of Medicare beneficiaries had unfavorable views of the new law, 26 percent favored it and the rest said they did not know enough to form an opinion.

Yesterday, Thompson celebrated what he called successes, but said he left unfinished work - for example, in fully safeguarding the nation's food supply from terrorists.

"I, for the life of me, cannot understand why the terrorists have not, you know, attacked our food supply because it is so easy to do," Thompson said.

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