September 23,2010

Grassley: Health Care Agency Leadership, Key Decisions Are Not Transparent

Senate Forum on the Centers for Medicare and Medicaid Services
Opening Statement of Senator Chuck Grassley
Ranking Member, Senate Finance Committee
Thursday, September 23, 2010

We have important issues to cover today and I’d like to thank my colleagues for their participation in this forum. In particular, I would like to thank Senator Hatch for his work with me to make this possible. And I’d like to thank our distinguished panel of witnesses who will be testifying today.

The purpose of today’s forum is to examine the important role of the Administrator of the Centers for Medicare and Medicaid Services, or CMS, and take a focused look at the need for transparency and accountability for such an important position. As many of you know, CMS is the agency responsible for implementing many of the changes made by the new health law. The CMS Administrator is also responsible for running the Medicare and Medicaid programs. As everyone here knows, the President nominated Dr. Donald Berwick to serve as the Administrator of CMS.  In the Finance Committee, we were well on our way to process his nomination.  In fact, the committee was ready to hold Dr. Berwick’s nomination hearing.   In the middle of June, I had requested a hearing on behalf of Republicans on the committee. But that hearing was not called. And then the President used his authority to recess appoint Dr. Berwick, which circumvented the open public review of his nomination.

That recess appointment bypassed the usual Senate confirmation process.  Typically, President’s use the recess appointment power when a nomination has been bogged down in committee or in the full Senate.  But that was not the case here.

Dr. Berwick is now in charge of an agency that has a bigger budget than the Pentagon, with spending that amounts to more than 5 percent of our nation’s economy.  Additionally, when the new health law was signed in March, the agency that Dr. Berwick now leads became responsible for significant changes to federal health programs, including over half a trillion dollars in Medicare payment cuts and the largest Medicaid expansion since the program’s creation.  CMS currently finances health care for one in three Americans – about 100 million people.  So, as the CMS Administrator, Dr. Berwick’s decisions will influence a significant amount of economic activity and determine how the new health law affects the health care coverage that millions of Americans rely on.

Throughout my career, I have been an advocate for transparency, and have defended the constitutional responsibility of the Senate to conduct a thorough review of the President’s nominees.   As such, I made repeated requests for Dr. Berwick to appear before the Committee, both before and after the recess appointment. Unfortunately, the Administration and the Democratic majority continue to refuse to hold a hearing for Dr. Berwick. So, that brings us to where we are today. Senator Hatch and I organized this forum to give Dr. Berwick the opportunity to present his qualifications.

Like most of the American public, members also want to hear Dr. Berwick’s plans for implementing health reform.

We invited Dr. Berwick to appear at today’s forum, but as you can see, he chose not to attend. This just shows how the Administration and the Democratic majority have maintained an utter lack of transparency when it comes to the implementation of their new health law. We wouldn’t be here today if it wasn’t such an important issue that we hear from Dr. Berwick. But we continue to write letters, request hearings, and organize forums because when the President recess-appointed Dr. Berwick, he quickly became one of the most powerful individuals in his administration.  The American people deserve to know about who is running this important agency and what plans are being made that affect them.

There is a regular process in place for Members of Congress, and the American people to get to know the President’s nominees.  As I said earlier, circumventing this process is not common. In fact, the Administration has to go out of its way to have a nominee avoid the regular committee review of their nomination.

That begs the question, why did the Administration go out of its way for Dr. Berwick? By avoiding the Committee’s questions and refusing to share important information, the legitimacy and authority of Dr. Berwick to serve as Administrator is called into question. So what is the Administration hiding? What is the Administration worried the regular nomination review process will reveal?

Today is the six-month anniversary since the President signed the health care law, and we still know very little about the man tasked with implementing so many of the changes.  For an administration that promised an unmatched level of transparency, this is not a good start. Although Dr. Berwick is not here to answer questions, we have three expert witnesses who have a good understanding of the new health law. In addition to highlighting some of the known effects, they will also help us understand how much of the new health law is left to the decisions made by Dr. Berwick, and his guarded plan for implementation.