WASHINGTON – Dr. Don Berwick, administrator of the Centers for Medicare and Medicaid Services, largely escaped criticism from the Republican senators during his first official appearance on Capitol Hill on Nov. 17, but several senators vowed that they would ensure that he answered all their questions in writing or at another hearing.
Dr. Berwick was appointed by President Obama in July while Congress was in recess. Thus, Dr. Berwick was never subject to confirmation hearings, leaving most Republicans and some Democrats saying that the legislative authority to confirm high-level executive branch appointments had been bypassed.
Dr. Don Berwick
Speaking before the Finance committee on Nov. 17, Dr. Berwick tried to soothe his potential critics by discussing the potential he sees in addressing the wrongs of the American health care system.
"I feel incredibly lucky to be able to join CMS at a historic time, a time of enormous promise for the future of our nation’s health care," he said. He added that he felt that the federal government "should aim for three goals simultaneously: better care for individuals, better health for the American people, and lower costs through improvement."
The Affordable Care Act (ACA) is "the best opportunity we’ve had in a generation or more to make progress," said Dr. Berwick.
The hearing was led by Chairman Max Baucus (D-Mont.), who scheduled 1 hour for opening statements, testimony, and questioning – an unusually short duration for any congressional committee hearing.
Democratic members of the panel used their allotted 5 minutes of questioning to express enthusiasm for various parts of the ACA and to give Dr. Berwick the opportunity to do the same. Republicans mainly expressed concern that they did not have the ability to properly question Dr. Berwick, given the hearing’s tight timeline.
During his turn to question the CMS administrator, the committee’s ranking minority member, Sen. Chuck Grassley (R-Iowa), wanted to know whether Dr. Berwick supported the conclusions of an April report by Rick Foster, the Medicare Chief Actuary. According to Sen. Grassley, that report said that the reductions envisioned in the ACA would threaten beneficiaries’ access to care.
Dr. Berwick countered that Mr. Foster’s estimates were just that – estimates based on his best judgement.
"Our intention is to increase access to care," he told Sen. Grassley. He added that beneficiaries will "find themselves in better shape after implementation of this act is fully engaged."
Sen. Orrin Hatch (R-Utah) also queried Dr. Berwick about the actuary’s report. But he used most of his time to complain that the CMS Administrator – in charge of a budget that is larger than the Pentagon’s, as he noted – had not been available until that day.
"Obviously, asking us to cover all of our concerns in this hour-long hearing with only 5 minutes...per person, is like asking us to drain the Pacific Ocean with a thimble," Sen. Hatch said.
He said that he hoped that Dr. Berwick would answer any and all questions put to him in writing and that the Administration would allow him to fully answer the queries.
Sen. Hatch and Sen. Grassley and other Republicans asked for additional hearings with Dr. Berwick after the Thanksgiving break, but Chairman Baucus was noncommittal about scheduling such an event.
That prompted a blunt assessment from Sen. Jim Bunning (R-Ky.), who is not returning for the next Congress.
"I can assure you that you will not get special treatment next year," when Republicans hold the majority in the House. "I suspect that you will be spending a lot of time testifying before the House of Representatives, partly because we in the Senate have been shut out," Sen. Bunning said.