Top Obamacare Chief to Step down Next Month

Marilyn Tavenner, the soft-spoken former nurse who for the past 18 months sat in the hot seat during the bumpy rollout of the Affordable Care Act, will leave the Centers for Medicare and Medicaid Services in February, the Health and Human Services Department announced Friday.

HHS Secretary Sylvia Mathews Burwell in an email to staff called Tavenner “one of our most esteemed and accomplished colleagues,” and announced that her position as CMS administrator will be filled on an acting basis by Principal Deputy Administrator Andy Slavitt.

“It’s a great testament to the respect she’s earned that Marilyn was the first administrator to be confirmed by the Senate in six and a half years – and she was confirmed with overwhelming, bipartisan support,” Burwell said of Tavenner’s May 2013 confirmation after two and a half years doing other work at HHS. “She is a big part of the reason why, as of this past spring, roughly 10 million Americans had gained health coverage since last year – the largest increase in four decades. Under her watch, the solvency of the Medicare Trust Funds was extended to 2030.  In addition, her work on health care quality helped our nation achieve a 17 percent reduction in hospital acquired conditions – saving an estimated 50,000 lives and $12 billion in health care costs.” 

Tavenner’s own email to colleagues described her “sadness and mixed emotions,” but did not specify a reason for leaving. Citing CMS’ longtime role as “the biggest payer of health care services in the United States” and the added workload following enactment of President Obama’s signature health care reform, Tavenner said, “With those changes came a whole new set of responsibilities and a spotlight that brightly shown on all of us as we managed the largest federal agency budget, strong opinions across the nation, and our ultimate mission of improving our country’s health care system and saving lives. But with your hard work, dedication, commitment and resolve, you cleared the path and laid out a plan for all that we needed to accomplish.  As a result, you are truly transforming health care in this country.”

Tavenner, a former private sector health care executive, pointed to progress in controlling costs through such tools as Accountable Care Organizations and Patient Centered Medical Homes. She lauded the Affordable Care Act’s new administrative authorities to combat Medicare fraud and abuse, in part through the use of data analytics. 

In the area of access, “Another one of our achievements has been our ability to grant so many of our citizens with much needed access to health care through both the marketplace and Medicaid expansion,” Tavenner wrote. “Setting up a major, complex and unprecedented system such as the marketplace came with many challenges, and it touched the work of everyone in this agency.”

Tavenner informed employees that her chief of staff, Aryana Khalid will also be departing, in March.

Though Obamacare remains politically divisive—Republican efforts to repeal it continue both in the new Congress and in courts—Tavenner leaves an impression of strength and competence in the view of many.

At a contentious October 2013 hearing on the botched rollout of the health insurance website, Tavenner displayed grace while delivering the administration’s case for patience while flawed website coding gets repaired. “I want to apologize…that the website has not worked as well as it should,” she said. “We know how desperately you need affordable coverage ... this initial experience has not lived up to our expectations or the expectations of the American people and it is not acceptable.”

Sen. Orrin Hatch, R-Utah, newly installed as chairman of the Senate Finance Committee, issued a statement Friday saying, "Marilyn has done a great job in a very difficult position under near-impossible circumstances. She has proven herself to be a strong leader and a straight-shooter who brought in much needed private-sector sensibility into the agency."

Sen. Charles Grassley, R-Iowa, said, “I’ve had a positive working relationship with Administrator Tavenner.  I respect her abilities and her willingness to engage in open and often productive conversation.  CMS administrator is a tough job under regular circumstances, and hers was especially hard in implementing a misguided new health care law.  I wish her well.”

Newly installed House Oversight and Government Reform Committee Chairman Jason Chaffetz, R-Utah., declined comment to Government Executive, but his predecessor, Rep. Darrell Issa, R-Calif., on Friday blasted Tavenner for initially including dental plans in releases on the numbers of Americans signing up at the exchanges.  “Tavenner had to go,” Issa said. “She presided over CMS as it deceptively padded the Obamacare enrollment numbers. It was a deplorable example of an agency trying to scam the American people. They weren’t successful this time because of Congressional oversight. We deserve better.”

Enroll America, a nonprofit working to recruit more patients to sign up for health insurance, praised Tavenner in a statement to Government Executive. “Tavenner played a critical role in the historic implementation of the Affordable Care Act,” said Anne Filipic, the group’s president. “The initial rollout of such a monumental expansion of coverage presented huge challenges, but her commitment to continuously improving consumer experience on the Health Insurance Marketplace has allowed millions to enroll in quality, affordable health insurance. And thanks to her leadership overseeing expansions and improvements to Medicaid and CHIP, health coverage became a reality for millions more Americans. We thank Administrator Tavenner for her years of public service; her work will improve the lives of Americans for years to come.”