What’s Next In The Senate: In The Coming Weeks And After 2014

Jackie Judd talks with KHN’s Mary Agnes Carey about what’s next for the stalled confirmation of Marilyn Tavenner, and who will fill the void in health policy when three senior Senate Democrats retire in 2014.

>> Listen to their conversation here.

JACKIE JUDD: Good day, this is Health on the Hill. I’m Jackie Judd. A stalled confirmation and retirements among senior Senate Democrats involved in health care policy top our conversation today with Mary Agnes Carey of Kaiser Health News. Welcome, as always. Well, for a minute there, it looked like Marilyn Tavenner, who has been heading the [Centers for Medicare & Medicaid Services] for sixteen months now, was finally going to get a full Senate vote. And then it didn’t happen because of [Iowa Sen.] Tom Harkin. What does he want?

MARY AGNES CAREY: Tom Harkin, who championed funding for prevention in the health law, is upset that the administration is going into that fund to take money out to implement the health care law. And the reason they’re doing that is the administration has asked for more funding from Congress, but Republicans on Capitol Hill don’t want to grant that request. So as we know the health law’s exchanges have to be up and running this fall, the navigators who are supposed to help people understand how to navigate the exchanges need to be up and running, and so the administration has got to go into existing funding, including the prevention fund.

JACKIE JUDD: But Harkin believes that there are other sources of funding.

MARY AGNES CAREY: He does.

JACKIE JUDD: And has he made any headway with the White House?

MARY AGNES CAREY: Not that we know of yet. I’m sure that they’re having conversations back and forth, and one thing that intrigues me – to your point – is Tom Harkin is an appropriator. He’s on the Senate Appropriations Committee, he runs the subcommittee that oversees HHS, and when Tom Harkin says: I think there are other places they can get the money, I have a feeling that they’ll listen to that.

JACKIE JUDD: Let’s presume that Marilyn Tavenner eventually will be confirmed by the full Senate. What is the practical impact of her being the head of the agency as opposed to the acting?

MARY AGNES CAREY: I think when you are confirmed as the administrator of an agency, it gives you a little more gravitas to express your vision of where you think it needs to go and to get that vision implemented. Now, to be sure, the agency hasn’t had a confirmed administrator since 2006, and they have been working very hard – employees there – to implement Medicare and Medicaid and so on. But I think that it’s that extra oomph – to use that word – if you are confirmed as administrator.

JACKIE JUDD: Mary Agnes, Tom Harkin is one of three [Senate] Democrats who has announced their retirement. One of three involved in health care issues – Jay Rockefeller, West Virginia is another; Max Baucus, of course, who is currently chair of the Finance Committee. It’s going to be a real policy drain. Again, an impact question. What is the impact when three people like that – three lawmakers very committed in their own ways to health care policy – what impact may it have?

MARY AGNES CAREY:  I think looking ahead, before the 2014 elections all of these senators had made it very clear that they’re going to use their power to implement the health law as they see fit. We’ve just talked about Tom Harkin. We can’t forget about Max Baucus, head of the Senate Finance Committee, who just a week or so ago grilled Secretary Kathleen Sebelius, who heads HHS, saying that he saw a “train wreck” coming on implementation of the health law.

And Jay Rockefeller is another health care champion on Medicare, Medicaid and the ACA, so I think leading up to the election, while people know they’re not going to be around after 2014, they also know they’ll be wielding the power they have before that point.

JACKIE JUDD:  But will they suffer from being lame ducks?

MARY AGNES CAREY:  To some extent, one can make that argument.

For example, Max Baucus has been in negotiations with Dave Camp of the House Ways & Means Committee about a possible overhaul of the tax code. And there are thoughts that that may weaken Sen. Baucus’ ability to negotiate that — or if they chose to look at the entitlement structure.

But, again, 2014 is a bit away, that election, and I do think the lame duck thing does figure in, but they will work as hard as they can this year to try to avoid that.

JACKIE JUDD:  Presuming that Democrats maintain control of the Senate after the 2014 elections, who is waiting in the wings? Who will be the new Tom Harkin? New Rockefeller? The New Baucus?

MARY AGNES CAREY:  There are many, many Democrats who are very strong on health care. But here are some people that I have watched that I think are very interesting to follow:

When you talk about health care and Democrats, you’ve got to talk about Ron Wyden of Oregon. He is behind Sen. Baucus, behind Sen. Rockefeller, the next ranking Democrat to take over Finance. He may or may not be the Finance chairman, but he’s got a long tenure on that committee.  He started his career with the Gray Panthers. He knows a lot about Medicare and Medicaid. He has reached across the aisle. He sponsored something called the Healthy Americans Act with Bob Bennett, the former Republican senator of Utah, that would de-link insurance from employment.

He worked with Paul Ryan, the House Budget chairman, Republican in the House, on an early version of premium support – not the one that’s currently in the House budget, but an earlier version of that. So he’s one to keep your eye on.

I think Ben Cardin, who is on the Finance Committee, a former House Ways & Means Committee member, is very interesting. He asks a lot of very interesting questions on Medicare and Medicaid. And Sherrod Brown is another Democrat, formerly in the House. He’s a former member of the Health, Education, Labor & Pensions Committee in the Senate. He’s now on Finance. And for 18 years, Sherrod Brown would not take the health insurance that’s offered to members of Congress and their staffs, because he felt it was not fair for him to have that advantage over his constituents. But since the passage of the ACA, he has enrolled in that insurance. But I think he’ll be one to watch on health care, as well.  

JACKIE JUDD:  Thanks so much, as always, Mary Agnes Carey of Kaiser Health News.