Top FDA Official Tapped to Guide Medicare Reform

President Bush said Friday that he would nominate the commissioner of the Food and Drug Administration to run the agency that operates the Medicare and Medicaid programs, moving a skilled and loyal aide to a politically sensitive position.

Dr. Mark B. McClellan, a physician who has a doctorate in economics, has been confirmed twice by the Senate for top administration jobs. Unless he meets unexpected opposition on his third trip, he will be responsible for overseeing the most comprehensive changes to Medicare in its 38 years.

Analysts said his nomination as administrator of the Center for Medicare and Medicaid Services reflects the administration’s desire to avoid a bruising confirmation battle that would give Democratic lawmakers another opportunity to tear down Medicare reform.

The law, enacted last year, establishes a prescription drug benefit and gives private insurance companies billions of dollars to attract seniors and disabled persons away from the traditional program and into managed care.

Bush has planned to make creation of the prescription drug benefit a centerpiece of his reelection campaign. But so far, the Democratic presidential candidates and many Democratic lawmakers have scored political points by arguing that the law does more for drug manufacturers and HMOs than for the program’s 40 million beneficiaries.

Some conservative Republican lawmakers who voted for the Medicare reform bill, enabling it to squeak through the House, have expressed their anger with the administration over recent budget figures that peg its 10-year cost at $530 billion -- one-third higher than the original estimate of $400 billion.

Administration officials and leading Republicans in Congress have sought in recent weeks to highlight the lower HMO premiums soon to be available to some seniors and a stop-gap Medicare-endorsed drug discount card that will be available to all seniors in June.

Despite the conflict surrounding the law, its supporters and opponents, Democrats as well as Republicans hailed Bush’s choice.

“Dr. McClellan is the brightest, most capable person I know in formulating and implementing healthcare policy,” said Senate Majority Leader Bill Frist (R-Tenn.) “In selecting Dr. McClellan, the president has clearly picked the best man for the job.”

Sen. Edward M. Kennedy (D-Mass.), Congress’ strongest critic of the Medicare reform law, called McClellan a superb choice. “He enjoys the respect of members of Congress on both sides of the aisle, and he brings to the job a powerful intellect, a deep knowledge of the programs and a commitment to public service,” he said.

But Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group and a longtime critic of the FDA, said he was concerned that by approaching the job more as an economist than a physician, McClellan could become a “cheerleader for the privatization and serious weakening of Medicare.”

The transfer of McClellan, 40, from his current high-profile job to what has been a largely administrative position “also reflects the administration’s judgment that the task of getting this program implemented is more politically important than the task of running the FDA,” said John Rother, director of policy and strategy at AARP.

Senate Finance Committee Chairman Charles E. Grassley (R-Iowa) said his panel would move quickly to consider McClellan’s nomination. “CMS has more responsibility than ever before. We need a CMS leader who understands how to do the job not just adequately, but very well,” Grassley said.

McClellan’s brother Scott, the White House spokesman, said: “We will be moving forward quickly on this nomination because it’s a very important priority to make sure we are implementing the improvements in the Medicare legislation to help our seniors get the best possible medical care.”

The top Medicare job has been vacant since December, when former administrator Tom Scully resigned. The White House said Deputy Commissioner Lester Crawford would become acting commissioner. Both the FDA and CMS are part of the Department of Health and Human Services.

Taken together, Medicare -- which provides health benefits to more than 40 million people -- and Medicaid, the state-federal health safety net for almost 44 million low-income Americans, will spend a projected $482 billion in federal funds over the next fiscal year.

Before taking the FDA post in November 2002, McClellan served on the White House Council of Economic Advisors.