Facing the prospect of an acrimonious nomination fight that threatened to reprise last year's healthcare debate, President Obama will bypass the Senate to appoint a new head of the federal Medicare and Medicaid health insurance programs, the White House announced Tuesday evening.
Dr. Donald Berwick, a Harvard pediatrician and expert on healthcare quality, was nominated in April to head the Centers for Medicare and Medicaid Services, or CMS, one of the top healthcare positions in government.
But with Republicans lining up to oppose Berwick, Obama will make a recess appointment Wednesday, administration officials said.
"Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points," White House Communications Director Dan Pfeiffer said in a blog post Tuesday announcing the decision.
"But with the agency facing new responsibilities to protect seniors' care under the Affordable Care Act, there's no time to waste with Washington game-playing."
With Congress away, Berwick will be able to assume his new assignment without going through a confirmation process.
Senate Minority Leader Mitch McConnell (R-Ky.) accused the administration of sneaking Berwick through, calling the recess appointment and the lack of a confirmation hearing "truly outrageous."
"As if shoving a trillion-dollar government takeover of healthcare down the throat of a disapproving American public wasn't enough, apparently the Obama administration intends to arrogantly circumvent the American people yet again by recess-appointing one of the most prominent advocates of rationed healthcare to implement their national plan," McConnell said in a statement.
The new law strives to make Medicare more efficient as well as dramatically expand Medicaid, the joint state-federal insurance program for the poor.
Approximately 47 million people are enrolled in Medicare, and 58 million people are enrolled in Medicaid.
Berwick, 63, is a leading advocate of expanding research into the comparative effectiveness of various medical treatments, a major focus of the new healthcare law that many experts think is crucial to improve the quality of care that Americans receive and cut waste in the system.
He has been praised by the American Medical Assn., healthcare groups, consumer advocates and former CMS directors, including Dr. Mark McClellan and Thomas A. Scully, both of whom served in the George W. Bush administration.
But GOP senators accuse Berwick of embracing cutbacks to Americans' access to healthcare, citing his laudatory comments about the British healthcare system, which evaluates the cost of medical treatments in making coverage decisions.
"The decision is not whether or not we will ration care," Berwick told an interviewer last year. "The decision is whether we will ration with our eyes open. And right now, we are doing it blindly."
Sen. John Barrasso (R-Wyo.) alluded to that comment on the Senate floor last month, saying, "The new director of Medicare is planning to ration care."
But Ron Pollack, who heads the influential consumer group Families USA, praised Obama's decision to move forward with Berwick's appointment.
"Don Berwick is as knowledgeable and accomplished as anyone in promoting quality healthcare, and his appointment augurs well for the effective implementation of health reform," Pollack said.
Recess appointments are often controversial, but they have been used by both parties. President Clinton made 139 of them and President George W. Bush made 171.