Senators Now On The Front Line

U.S. Sen. Lisa Murkowski (R-AK) leaves after a vote in an elevator at the Capitol February 1, 2017 in Washington, DC. I am heartened by the opposition of Senators Murkowski and Collins to the appointment of Betsy DeVos as Secretary of Education. I hope that signals more independence ahead. For me, personally, there is a bit of a back story. In July, 2010, President Obama used his recess appointment authority to make me the administrator of the Centers for Medicare and Medicaid Services – CMS. That was not the original plan. When I was first asked to do that job, in 2008, shortly after the presidential election, the aim was a Senate confirmation. But with the polarized politics following that election and the intense maneuvering that led to the narrow passage of the Affordable Care Act, the administration judged it better to delay my formal nomination for almost a year and a half, until April, 2010. By then, hope for my prompt confirmation was gone, and recess appointment was the only timely option the president had. CMS had had only Acting administrators for the previous six years, and, especially given its extensive role in implementing the ACA, leadership there had become an urgent priority. The administration told me that it hoped for enough détente in the ensuing months to move my confirmation forward in the Senate. But that was not to be. In March, 2011, 42 senators, led by Senator Orrin Hatch, sent a letter to President Obama demanding that he withdraw my nomination. That letter was dripping with misinformation and completely ignored the extensive support for my nomination from a wide range of health care stakeholders, most of whom knew me far better than the signatories did. The president stuck by me. But, no matter; 60 Senate votes were required to beat a filibuster, and my confirmation was therefore dead. I served for the rest of my recess appointment term, which ended in December, 2011. Leading CMS gave me the chance to contribute to the health and wellbeing of tens of millions of Americans and to launch a fleet of effective efforts to help make our health care system better. I felt lucky to serve, and sad to have to leave. But, there is a sweet nuance to the story: five of the then 47 Republican senators did not join the 42 who signed the Hatch letter. Two are no longer in office: Scott Brown and Olympia Snow. But three are: Senator Susan Collins, Senator Lisa Murkowski, and Senator Rob Portman. Given the hermetic party discipline of that time, their dissent seemed remarkable. I did not know then, nor do I now, why they did not sign. Maybe they just missed the memo. Or maybe they were holding out for the due process and fair play of an open hearing. Or maybe they trusted the judgment of the American Hospital Association, the American Medical Association, AARP, and dozens of others who had praised my nomination. I prefer to assume […]

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