McClellan successor faces tough issues on Medicare

Agency chief, leaving after 2 years, wins praise from program's critics

September 06, 2006|By Jonathan D. Rockoff | Jonathan D. Rockoff,Sun reporter

WASHINGTON -- Supporters and critics offered praise for Dr. Mark B. McClellan, who announced yesterday that he is resigning after more than two years as head of the agency that runs Medicare and Medicaid.

No replacement has been named, though White House officials have reportedly known for some time that McClellan, a Texan who held several top posts in the administration, planned to leave.

Two top officials of the Centers for Medicare and Medicaid Services have been mentioned as possible successors: Leslie Norwalk, deputy administrator, and Herb Kuhn, who runs the fee-for-service portion of Medicare.

McClellan oversaw one of the largest expansions in Medicare's history, the addition of a prescription drug benefit for seniors. Worn out by late nights and work-filled weekends, he said, he wants to spend more time with family.

"It is really time to spend dinner with my girls, rather than on the road implementing so many programs," said the 43-year-old father of young twin daughters. McClellan said he might return to Stanford University, where he taught, or join a think tank, after leaving his job next month.

He was praised for his efforts to balance the political demands of his job with sound policy since leaving the White House staff to run the agency, which has its headquarters in Woodlawn.

"It's a big loss to the country," said Republican Rep. Jim McCrery of Louisiana, a leader in the House on Medicare and Medicaid issues. "He's a very talented guy."

Ron Pollack, executive director of Families USA, an interest group that has criticized the design of the prescription drug benefit and cuts in health care coverage for the poor and elderly, blamed the Bush administration and Congress, rather than McClellan.

McClellan, said Pollack, "did an extraordinarily fine job in the context of [having to implement] terrifically lousy policy."

In a statement, President Bush hailed McClellan for taking steps that will lead to patients receiving better care at lower prices. "Mark has been a trusted adviser and he leaves behind a strong record of accomplishment," Bush said.

McClellan's replacement will face an unwieldy, highly political job. Medicare and Medicaid make up the country's biggest health insurer, with a yearly budget of almost $600 billion and about 90 million recipients. The programs pay for the medical care of seniors, the disabled and the poor.

Among the issues that the next chief could face: a 5 percent cut in overall reimbursements for doctors, though McCrery indicated that Congress might delay the cuts for a year in order to reach a final decision. The agency will also have to find ways to curb the growth in government spending on health care, according to health policy specialists.

"It's impossible to give doctors more money, give patients everything they want and keep taxes down," said Jonathan Weiner, a professor at the Johns Hopkins Bloomberg School of Public Health.

An immediate task for McClellan's successor will be improving Medicare Part D, the new program that pays for many drugs for seniors. Some beneficiaries have had to pay thousands of dollars because of a feature of the plan that critics want to alter. There are other problems that even those largely satisfied with the new benefit want changed.

"I hope his departure doesn't cause delays in getting Part D snags fixed for beneficiaries, and that he'll correct all known problems before he leaves," Sen. Charles E. Grassley, the Iowa Republican who chairs the Finance Committee, said in a statement.

Democrats have assailed the prescription drug benefit since a bumpy start in January, which included mistaken refunds to 230,000 beneficiaries last month. Should Democrats win enough seats during the November election to take over one or both houses of Congress, the next administrator could face hearings on the program.

"The world turns upside down on CMS if the Democrats take control of the House," said Drew Altman, president of the Henry J. Kaiser Family Foundation, a nonprofit research group.

A physician and economist by training, McClellan has close ties to Bush. His mother is Texas Comptroller Carole Keeton Strayhorn - an independent candidate for governor - and his brother Scott was White House press secretary. Mark worked in the White House and led the Food and Drug Administration before taking over Medicare and Medicaid in early 2004.

Though his tenure was marked by the implementation of the new prescription drug benefit, McClellan undertook other initiatives, such as promoting preventive health care and linking payments to the quality of services.

"He said Medicare needs to be a public health agency. Its decisions should be driven by promoting good public health," said Dr. Sean Tunis, who was a high-ranking CMS official under McClellan until leaving last year.

Sun reporter Julie Hirschfeld Davis contributed to this article.

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