Keeping Cool in the Obamacare Pressure Cooker

WASHINGTON, DC - NOVEMBER 05: Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner testifies before the Senate Health, Education, Labor and Pensions Committee on Capitol Hill, November 4, 2013 in Washington, DC. The committee is hearing testimony from Administrator Tavenner on the enrollment troubles with the website and the online federal insurance marketplace.
National Journal
Sophie Novack
Nov. 18, 2013, 4:48 p.m.

As ad­min­is­trat­or of the Cen­ters for Medi­care and Medi­caid Ser­vices in the midst of the biggest crisis in the agency’s 48-year his­tory, Mar­ilyn Taven­ner is tasked with im­ple­ment­ing one of the most polit­ic­ally po­lar­iz­ing laws ever. Not to men­tion that the Obama­care rol­lout is not go­ing so well.

Yet Taven­ner her­self has been spared much of the blame for what all sides are call­ing a calam­ity — and, even now, she re­tains much of the bi­par­tis­an sup­port she had when she was con­firmed by the Sen­ate on a 91-7 vote in May. She is a former hos­pit­al ad­min­is­trat­or and top state health of­fi­cial in Vir­gin­ia, and her ex­tens­ive ca­reer out­side Wash­ing­ton seems to have shiel­ded her from much of its wrath.

“She had no real ex­pos­ure to polit­ics,” said Laurens Sar­tor­is, pres­id­ent of the Vir­gin­ia Hos­pit­al and Health­care As­so­ci­ation, who has known and worked with Taven­ner for dec­ades. “Ob­vi­ously, to sur­vive, you have to have good polit­ic­al skills and sens­it­iv­it­ies, but I don’t think any­one would char­ac­ter­ize her as a politi­cian. She’s someone who is a com­pet­ent ad­min­is­trat­or — she runs or­gan­iz­a­tions to get cer­tain res­ults. That ap­proach is really an apolit­ic­al one.”

Born in Mar­tins­ville, Va., in 1951, Taven­ner spent the ma­jor­ity of her ca­reer in Vir­gin­ia. She began as a nurse at the John­ston Wil­lis Hos­pit­al in Rich­mond in 1981 and rose to be­come its CEO 12 years later. She then climbed the lad­der in the par­ent com­pany, the Hos­pit­al Cor­por­a­tion of Amer­ica, be­com­ing pres­id­ent of HCA’s Cent­ral At­lantic Di­vi­sion and its 20 hos­pit­als in 2001 and later mov­ing up to group pres­id­ent of out­pa­tient ser­vices.

In 2006, Vir­gin­ia’s Demo­crat­ic gov­ernor, now-Sen. Tim Kaine, ap­poin­ted Taven­ner sec­ret­ary of Health and Hu­man Re­sources, put­ting her in charge of a de­part­ment with a $9 bil­lion an­nu­al budget and 18,000 em­ploy­ees. Four years later, she be­came the prin­cip­al deputy ad­min­is­trat­or at CMS and then was named act­ing ad­min­is­trat­or in Decem­ber 2011; a year and a half after that, the Sen­ate over­whelm­ingly con­firmed her ap­point­ment as CMS ad­min­is­trat­or.

Those who have worked with Taven­ner de­scribe her as smart, hard-work­ing, and dir­ect. “She’s the con­sum­mate pro­fes­sion­al,” said Patrick Fin­nerty, who was Medi­caid dir­ect­or in Vir­gin­ia un­der Taven­ner. “Her ap­proach was, an is­sue comes up, we fix it, and we move on.”

The fix-it-and-move-on way of do­ing busi­ness is prov­ing dif­fi­cult with the prob­lems plaguing Health­, and Taven­ner has test­i­fied at a couple of lengthy con­gres­sion­al hear­ings in re­cent weeks — ex­per­i­ences she clearly would have pre­ferred to avoid.

“There are two things Mar­ilyn is not in­to,” Sar­tor­is said. “The first is hav­ing more ma­ter­i­al be­fore her­self or someone else than what is needed to make the right de­cision. Second is, she doesn’t like to hear her­self talk. She’s not one to walk in a room and search for the mi­cro­phone.”

In both the House and the Sen­ate com­mit­tee hear­ings, the law­makers of­ten spoke more than the ad­min­is­trat­or. At a hear­ing of the House Ways and Means Com­mit­tee, ten­sions ran high between pan­el mem­bers, but even staunch op­pon­ents of Obama­care were sur­pris­ingly pleas­ant to Taven­ner.

Of course, her long work­ing re­la­tion­ship with House Ma­jor­ity Lead­er Eric Can­tor, R-Va., doesn’t hurt. “Thank you so much for be­ing here,” Rep. Tim Griffin, R-Ark., said as he greeted Taven­ner at the Ways and Means hear­ing. “I’ve heard a lot of good things about your work from Lead­er Can­tor. So thank you for be­ing here, and I wish you well.”

Can­tor, who worked with her in Rich­mond, has en­dorsed Taven­ner in the past, and he fo­cuses blame for the Health­ rol­lout on Health and Hu­man Ser­vices Sec­ret­ary Kath­leen Se­beli­us.

Ways and Means Com­mit­tee rank­ing mem­ber Sander Lev­in, D-Mich., said Taven­ner’s bi­par­tis­an ap­peal is likely a res­ult of her pro­fes­sion­al his­tory. “She’s not someone with a strong elect­ive or polit­ic­al back­ground,” Lev­in said. Se­beli­us, on the oth­er hand, is a mem­ber of Pres­id­ent Obama’s Cab­in­et, he said, “and the pres­id­ent has been the main tar­get.”

“I think the dif­fi­culties have made her all the more de­term­ined to try to make the [Af­ford­able Care Act] work,” Lev­in said. “[Taven­ner] has de­voted her en­tire pro­fes­sion­al ca­reer to mak­ing health care more ac­cess­ible. There’s no ques­tion about her ded­ic­a­tion.”

While calls for Se­beli­us’s resig­na­tion have been loud and nu­mer­ous, law­makers have been less eager to point fin­gers at Taven­ner, even though it is her name on oft-cited CMS doc­u­ments au­thor­iz­ing the Oct. 1 launch of the fed­er­al ex­change web­site des­pite some con­cerns about po­ten­tial se­cur­ity risks.

“Sen­at­or Hatch has al­ways found Mar­ilyn Taven­ner to be bright and cap­able,” Ju­lia Law­less, spokes­wo­man for Sen. Or­rin Hatch, R-Utah, wrote in an email. To be “tasked with over­see­ing a massive bur­eau­cracy like the one at CMS is cer­tainly no small feat.”

As rank­ing mem­ber of the Sen­ate Fin­ance Com­mit­tee, Hatch sup­por­ted Taven­ner in her con­firm­a­tion hear­ing. Even Sen. Pat Roberts, R-Kan. — an old fam­ily friend of Se­beli­us’s who is also on the Fin­ance Com­mit­tee — has called on the sec­ret­ary to resign yet kept mum on Taven­ner.

While Taven­ner’s role over­see­ing im­ple­ment­a­tion of the health care law is now cer­tainly unique, ad­mirers be­lieve she will con­tin­ue to ap­proach her work with the same fo­cus she had in her hos­pit­al years. “I would as­sume Mar­ilyn will do what she al­ways does,” Sar­tor­is said, “which is buckle down and keep the pro­gram mov­ing along.”

Sar­tor­is ad­ded, un­promp­ted, that Taven­ner has the right at­ti­tude about the job — and about life in gen­er­al.

“When you’re watch­ing her sit at that table, when there’s not a lot of hu­mor in the room, it may be hard to com­pre­hend,” he said. “But she has a won­der­ful sense of hu­mor and per­spect­ive on things. You have to have one — in that stew pot, you would go nuts if you wer­en’t able to take a step back. I’d be ter­ri­fied to sit in that seat.”

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