Dr. Berwick renominated for permanent CMS post

Washington -- President Obama once again has formally nominated Donald M. Berwick, MD, to serve as Centers for Medicare & Medicaid Services administrator, more than six months after the president bypassed the Senate to place him in the position.

Under the recess appointment Obama made in July 2010, Dr. Berwick may serve as CMS chief only through the current congressional session, which will expire at the end of this year. The administrator may serve longer if his official renomination, issued Jan. 26, leads to a Senate confirmation.

Confirmation may be difficult to achieve, because any one senator may block the nomination and force Democrats to obtain 60 votes to overcome the objection.

When Obama first sidestepped the upper chamber to install Dr. Berwick, White House officials said Senate Republicans were intent on dragging out the nomination process as long as possible to score political points against the recently enacted health system reform law. The officials said the permanent CMS position, which had been vacant for more than three years, was too important to remain unfilled. It was not clear at the time whether Democrats could muster the 60 votes needed to confirm the candidate.

The nomination of the pediatrician and Harvard professor, who also heads the Institute for Healthcare Improvement, had the support of numerous consumer and physician organizations, including the American Medical Association. But critics said some of Dr. Berwick's statements and scholarship indicated he would be in favor of government rationing of health care.

The time that has elapsed since the nominee was appointed to the CMS position does not appear to have tempered some of those criticisms against him. Sen. Orrin Hatch (R, Utah), the ranking GOP member on the Senate Finance Committee, said the latest move clashed with the call for bipartisanship Obama made in his Jan. 25 State of the Union address to lawmakers.

"A day after the president committed to coming together to move our country forward, he's chosen to renominate one of his most contentious nominees to head an agency that impacts the lives of more than 100 million Americans," Hatch said. "This is a disappointing decision."

But at least one Republican member of the Finance panel, which is designated to review the nomination before it reaches the Senate floor, welcomed the opportunity to give Dr. Berwick a hearing.

Dr. Berwick is "currently on the job without having had a nomination hearing before the committee of jurisdiction," said Sen. Charles Grassley (R, Iowa), who has strongly criticized the recess appointment. "Nominees with one-tenth that responsibility regularly get a hearing. If the Senate intends to vote on the new nomination and allow Dr. Berwick to serve beyond the end of his recess appointment, there should be a hearing."