Obama's Appointee Will Have Major Role in Implementing Health Care Law

WASHINGTON - The pediatrician and Harvard University professor President Obama appointed Wednesday to run Medicare and Medicaid will play a central role in implementing the nation's new health care law, predecessors and outside experts said.

Donald Berwick, whom Obama named to head the Centers for Medicare and Medicaid Services, drew praise from top medical groups, including the American Medical Association, but Republicans criticized the administration's decision to use a recess appointment to bypass the Senate confirmation process.

Although the agency is little-known outside the medical industry, it controls an annual budget of more than $800 billion and oversees two health programs - Medicare for seniors and Medicaid for the poor - with more than 90 million enrollees.

"Everything he does every day has an impact on every doctor, every hospital and every patient in the country," said Thomas Scully, who ran the agency from 2001 to 2004.

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Berwick will also play a pivotal role in implementing Obama's health care law - from finding a way to trim about $500 billion out of Medicare over the next decade to expanding Medicaid coverage by 16 million people. The agency has "very broad authority under the new law," said Mark McClellan, who ran the agency from 2004 through 2006.

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Obama nominated Berwick, 63, for the position April 19 but faced opposition from Republicans such as Senate Minority Leader Mitch McConnell, who called Berwick an "expert on rationing." The Senate Finance Committee did not schedule a hearing on his appointment.

Nearly 200 nominees are pending in the Senate. White House spokesman Robert Gibbs said the administration was forced to take action to avoid further delay on the critical post.

Republicans pounced on Obama's decision to bypass the regular appointment process. Iowa Sen. Chuck Grassley, the top-ranking Republican on the Finance Committee, said, "Accountability ... and transparency have been thrown overboard."

Sen. Max Baucus, D-Mont., who chairs the Finance Committee, also said he was "troubled" by the appointment process.

Nominees must be confirmed by the Senate, but the Constitution also lets the president make temporary appointments when Congress is in recess. Obama has made 18 recess appointments. George W. Bush made 171 such appointments while in office, and Bill Clinton made 139, according to the non-partisan Congressional Research Service.

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