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.
More Top Picks Best Solar Lanterns
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.