Medical Device Daily Washington Editor
Comity, not partisanship, was the order of the day yesterday when the Senate Finance Committee met to discuss the nomination of Kansas Gov. Kathleen Sebelius as Secretary of Health and Human Services (HHS), and the subject of irregularities with regard to her campaign finances was never brought up.
All the same, a crack appeared in the wall of Democratic Party philosophy on healthcare reform on the question of a mandate for enrollment in a health plan, and the nominee once again opted to make no commitment regarding the use of budget reconciliation to force through healthcare reform.
In his opening remarks, Senate Finance Committee chairman Max Baucus (D-Montana) made a point of emphasizing the responsibilities that go with the job of HHS secretary. He noted that HHS oversees Medicare, which he said "is at the heart of our compact with seniors and those with disabilities." He also mentioned that HHS oversees Medicaid and the Children's Health Insurance Program, and hence the department is intimately "involved in the effort to reform our ailing healthcare system."
Baucus's remarks also seemed to hint that he expected little or no opposition to the nomination. "I'm counting on you to help" in the effort to reform healthcare, he said. However, Sebelius smartly peppered her responses to questions with the phrase "if confirmed."
Sen. Chuck Grassley (R-Iowa), the committee's ranking member, highlighted the concerns of the GOP by remarking that where reform is concerned, "doing nothing is not an option, but as always, the devil is in the details." He took an implicit swipe at the prospect of the use of budget reconciliation to pass healthcare reform. "We can do it without some processes that have been circulating lately," Grassley said, describing reconciliation as "a partisan exercise that is not a real vehicle for reform."
Grassley also made the case that Americans "do not need a plan where the government sets the rates" paid to doctors and hospitals, a reference to proposals to establish a government healthcare system outside of or building on existing public-sector programs.
Former Kansas Republican Sen. Bob Dole went to bat for Sebelius, as he did on behalf of the first HHS nominee, Tom Daschle (Medical Device Daily, Jan. 9, 2009). He opened by noting the dominance of the committee, of Congress and of the White House by one party, remarking "the Democrats don't need to worry about bipartisanship" in order to pass bills and confirm nominations.
All the same, Dole remarked that Congress's greatest accomplishments came when "things were done in a bipartisan manner," which he said always has more credibility with voters. Nonetheless, he sounded hopeful. "If any committee can do it, the Finance Committee can."
"Gov. Sebelius understands bipartisanship," Dole told the committee, adding that "she's got a lot of good things done by her willingness to reach across the aisle." He also said that Sebelius has the chops to lead the department during a turbulent time. "If we have some namby-pamby leader at HHS, we'll never get anywhere," he said, stating further that Sebelius is "going to give us the leadership to get you through some of the very tough times you're going to have."
Sebelius made the case that where reform of healthcare is concerned, "action is not a choice, it's a necessity." She also hinted that she has the credentials to steer HHS through what promises to be a politically and administratively tortured path. "Kansas has been ranked high for healthcare affordability by insurers," she said as the former commissioner for healthcare insurance in the state, noting further that she has served as the state's governor at a time when the Republican Party held the majority in the state's legislature.
Sebelius said CMS "will have a vital role to play" in reform. "I want to work with you to assure that all those eligible" for public programs are enrolled, she stated, adding that long-term care is an issue and that CMS "will be a critical partner in expanding our capacity in providing community[-based] long-term care services."
"Should I be confirmed, health reform will be my mission," Sebelius affirmed. She also noted that "previous opponents of reform are now demanding it," and are engaged in the process, she said, declining to directly address the reconciliation question posed by Grassley.
Baucus asked Sebelius specifically about mandatory enrollment for all U.S. citizens, which he said is crucial to avoid cost shifting, noting that the addition of healthy, low-cost enrollees "would help make the market work." She responded that "the President is committed to . . . have a dialogue with Congress," but went no further than to state, "I think he's open to all proposals."
Sen. Mike Enzi (R-Wyoming), the ranking member of the Senate Health, Education, Labor and Pensions Committee, asked about reconciliation, noting that the previous nominee foreswore the mechanism. Enzi remarked that should Democrats resort to reconciliation, "it would be an indication that the other side won't listen because they don't need to listen," a reference to the solid majority enjoyed by congressional Democrats.
Sebelius refused to make a comment specific to reconciliation, answering only that "I've already learned some important lessons" about how to make legislation pass, given her history as "an elected official in a minority party."