Tommy G. Thompson Department of Health and Human Services Established: 1953 2003 Budget: $64.6 billion Full-time Employees: 61,000 Thompson's Salary: $171,900 Web Site: www.hhs.gov Overall Grade: B Back To Overview And Other Cabinet Grades

National Journal
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Friday, Jan. 24, 2003

Tommy G. Thompson never asked to be Health and Human Services secretary. He wanted to be Transportation secretary, and he only reluctantly agreed to take the HHS job because President Bush kept calling and asking.

Some Washington insiders, in fact, thought Thompson was a bad choice. They wondered whether this strong-willed governor with a shake-things-up attitude would last long in a bureaucracy where he would have to promote and defend someone else's ideas. Early on, Thompson "was very frequently in the doghouse because he moved too aggressively in some areas," one health care lobbyist said.

During the past two years, Thompson has taken hits for his handling of two key challenges. He was criticized for his public response to the anthrax outbreaks shortly after 9/11, particularly for his suggestion that the first two victims could have acquired the disease naturally, one perhaps from sipping from a stream. "The picture that sticks in people's minds is the whole 'water' comment," one HHS aide said.

In addition, Thompson was not a major player in the high-profile debate over Medicare prescription drug benefits during the 107th Congress. The administration managed the issue mostly from the White House, where health care adviser Mark McClellan was seen as the point person. Most members of Congress and their aides called McClellan -- not Thompson -- when they had a Medicare question.

Yet, despite his rough beginning, Thompson isn't packing his bags. To the contrary, he just bought a house in Alexandria, Va. If anything, Thompson, 61, says he is more committed to -- even passionate about -- his job, and Bush has taken steps to demonstrate his esteem for his HHS secretary.

Asked about Thompson during a recent interview, White House Chief of Staff Andrew H. Card Jr. smiled jovially. "Tommy Thompson is very candid," Card said, "but he's also kind of a can-do guy: 'If that's what the president wants me to do, I will do it! I don't want to do it -- I'd rather do something else -- but if that's what the president wants me to do, I will do it.'"

Bush has increased Thompson's responsibilities in several ways. Rather than taking him out of the picture after his initial missteps on anthrax, the president made him the administration's spokesman on the issue. These days, Thompson is widely credited with playing a key role in preparing federal, state, and local governments to respond to bioterrorism.

Moreover, there's no question about Thompson's role now on Medicare prescription drug benefits legislation, which is a top domestic priority for Bush in the 108th Congress. Since last fall, McClellan has been under Thompson's supervision, as head of the Food and Drug Administration. And when the president convened a meeting of top White House and HHS officials in December to establish a strategy on Medicare prescription drugs, attendees said that Bush pointed to Thompson and said: "You're the team. You are the team leader."

Inside Influence Grade: B
Thompson and Bush go way back. Thompson was close to Bush's father and jokes that he was the first President Bush's favorite governor until the former president's sons were elected. Thompson was also said to be George W.'s mentor at the National Governors Association.

"He and the president have known each other and respected each other for such a long time as governors," Card said. "It wasn't Tommy Thompson's first choice to be secretary of Health and Human Services. That says an awful lot about the president, and it says an awful lot about Tommy Thompson."

The president has given Thompson significant discretion to allow states to try new health care coverage approaches. In addition, Thompson had broad leeway to dole out $1.1 billion to the states to improve their public health infrastructures and readiness capabilities for bioterrorism. His plan for handing out the money was controversial, because it required states to draft time-consuming, detailed plans, but the administration gave him total control. And after Thompson urged the president to develop a position on stem-cell research, Bush acted quickly.

Despite his strong relationship with Bush, the secretary doesn't get everything he wants. Thompson recently appealed to the Office of Management and Budget when it appeared that HHS would get less than he wanted in the president's fiscal 2004 budget. In the end, Thompson not only failed to secure the extra money, he also lost out on a compromise that OMB Director Mitchell E. Daniels Jr. had offered.

At other times, White House officials have taken precautions to make sure the secretary doesn't get out in front of the president. White House officials have been particularly careful about Thompson's role in reauthorizing the 1996 welfare law. Thompson, after all, attracted national publicity for his welfare reforms while he was Wisconsin's governor. He has said that welfare can't be done on the cheap, a view that concerned some in the White House who hold the purse strings. HHS crafted the administration's position on welfare last year, but White House officials brought in veteran Hill aide Ron Haskins to offer support and make sure that Thompson stayed on the reservation.

Nevertheless, many expert observers don't consider it an assault on Thompson that he hasn't always run the show on prescription drugs or that he has had help on welfare. Thompson was plenty busy last year, dealing with bioterrorism. And it's not unusual for the White House to take the lead on major issues. During the Clinton administration, the White House -- not HHS Secretary Donna E. Shalala -- controlled health care policy.

"I think it's the desire of the White House, and maybe rightly so, that on such highly visible things as prescriptions, Medicare reform, it's such a hot political issue that it ought to be at the White House," said Senate Finance Committee Chairman Charles E. Grassley, R-Iowa.

Hill Clout Grade: B
Soon after he became HHS secretary, Thompson sought to solidify his existing relationships on Capitol Hill and to develop new ones. Both parties see him as likable and responsive.

"There have been instances where we've seen very fast corrective behavior," said House Ways and Means Committee Chairman Bill Thomas, R-Calif. "There have been proposed regulations that didn't look anything like what we thought we were doing, and instead of explaining it through three layers of bureaucracy, I went right to him and he fixed it."

Likewise, Rep. Henry A. Waxman, D-Calif., said he feels he can call on Thompson. When Waxman once expressed concern about the safety of cosmetic contact lenses, Thompson quickly investigated and had the FDA stop all sales. "He's certainly gone out of his way to reach out by taking my call and responding to my concern," Waxman said.

Thompson also has been a willing witness before Congress. He has even testified before subcommittees, a task that Cabinet secretaries usually pass along to subordinates.

Certainly Thompson does not deserve sole blame for Congress's inaction thus far on welfare and Medicare. Moreover, he has won legislative victories on public health and bioterrorism measures. He was also considered helpful in the House's passage of medical liability legislation and FDA measures.

Political Imperatives Grade: B
While they don't agree on everything, Bush and Thompson approach health care policy from the same ideological handbook. Both are conservatives who strongly oppose abortion. And as former governors, they both favor giving states flexibility in federal-state partnerships such as the welfare and Medicaid programs. All in all, Thompson has been quite helpful to Bush in keeping traditional GOP constituencies happy.

Early on, Thompson created goodwill with key GOP interest groups by working to reduce the regulatory burden on the health care industry. In the bigger picture, governors are thrilled with the new opportunities that Thompson has provided. HHS has approved 2,200 state requests for waivers from federal health care rules, which Thompson says has allowed states to expand coverage to 1.8 million people.

Some liberal groups complain that Thompson has rushed into Medicaid waivers that may harm the poorest beneficiaries. And, as one health care lobbyist put it, "advocates in the states don't know what's going on with [Medicaid] waivers, because of the White House penchant for secrecy." One consumer group is considering filing a lawsuit to challenge the waivers, and even Grassley has introduced legislation to open up the process.

Running The Department Grade: A
When Thompson arrived in Washington, HHS was generally thought to be operating efficiently. To Thompson, however, the status quo is unacceptable. He seems quite determined to be an innovative secretary who leaves the department better than he found it. "I abhor the status quo," Thompson said in an interview. "If you're not living on the edge, you're taking up too much space."

Early on, Thompson streamlined HHS's computer, personnel, and bookkeeping systems. He also changed the name of the Health Care Financing Administration to the Centers for Medicare and Medicaid Services and got more information out to seniors; HHS even bought TV ads featuring actor Leslie Nielsen.

Perhaps Thompson's biggest success was in getting HHS's geographically splintered agencies to coordinate more effectively. "Tommy has changed the nature of the organization," Shalala said. "I can't judge his effectiveness, but his priority is to centralize things." Under previous administrations, the Centers for Disease Control and Prevention in Atlanta, the National Institutes of Health in Bethesda, Md., and the FDA in Rockville, Md., operated fairly independently. Thompson's "One Department" initiative has fostered better lines of communication, contributing to the fight against terrorism.

Meanwhile, across the hall from his office, Thompson has created a $3.5 million state-of-the-art command center. It combines ground and satellite communications and backup systems to ensure that HHS officials can communicate with federal, state, and local officials in the event of an emergency-and even if the rest of the building is contaminated with a bioagent.

In light of all the changes at the department, a few HHS staffers argue that there's a reason to leave some things as they are. Others complain that some career staff are underused because Thompson relies heavily on his own inner circle of aides. But most staff members appear to be energized.

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