Meet Marilyn Tavenner, the Medicare nominee no one expects to win confirmation

February 8, 2013
President Obama has re-nominated acting Medicare administrator Marilyn Tavenner to head the agency.
President Obama has re-nominated acting Medicare administrator Marilyn Tavenner to head the agency.

President Obama surprised no one with his nominee for Medicare head: Marilyn Tavenner, the same woman who has already run the agency as acting director for over a year now. Before that, she served as deputy Medicare administrator. And before that, she worked as a hospital nurse -- even once bringing a patient back from the dead. Here's a rundown on your new -- and old -- Medicare administrator.

1. Tavenner, a nurse by training, spent most of her career in the private sector as a hospital administrator. Tavenner began her career as a nurse within two Virginia hospitals owned by the Hospital Corporation of America, one of the country’s largest hospital chains. She rose to chief hospital nursing officer and then chief executive officer. In 2010, she joined the Obama administration, as then-acting Medicare administrator Don Berwick's deputy.

2. The one word that many say best describes Tavenner: A pragmatist. When Berwick got the nod for Medicare administrator, he was known as one of health policy's big thinkers. He came up with the idea of a "triple aim" in health care - higher quality care, delivered at a lower cost, with better outcomes - that is now ubiquitous at health systems across the country.

Tavenner, by contrast, is known more as a pragmatist, who knows the ins and outs of administering a major hospital. “With Marilyn, you present the information, then she makes a decision, and you move on,” Patrick Finnerty, who served as Virginia’s Medicaid director under Tavenner, told us for a previous story. “She doesn’t make promises she can’t keep. There are differences of opinions, and she would try to work through those. She’s straight with folks but always respectful.”

3. She has won the support of House Majority Leader Eric Cantor. The two came up together in Virginia politics and have known each other since the mid-1990s, when Cantor represented part of Richmond in the Virginia House of Delegates and Tavenner a major hospital in the city. Cantor, in an interview last winter, told me he could "absolutely work with" Tavenner as a Medicare administrator.

"She would be a real benefit for patients," Cantor continued. "Obviously she’s operating within a context, within the structure of a law that I didn’t support, but I do think she will bring to the job a perspective of the American health care system that has made it so great, a system that’s based on the private sector.”

4. Even so, don't expect Tavenner to have a confirmation hearing anytime soon. The Senate Finance Committee had a whole year to act on Tavenner's first nomination, submitted in November 2011. No dice. This time around, don't expect anything different: Democrats aren't raring for a confirmation hearing that would put an Obamacare fight front and center when the payoff would be small. Tavenner has already served as acting administrator for a full year, without Senate confirmation.

Even before Obamacare, Medicare heads have been notoriously difficult to get confirmed: The agency has been without a confirmed head for seven years now. Why is it such a tough spot to fill? As Politico's Jen Haberkorn writes, a lot of it has to do with the size of the agency, one of the largest in the federal government, with a half-trillion dollar budget. "The agency's wide jurisdiction and massive budget," she writes, "have provided loads of fodder for scuffing up nominees or discouraging presidents from even putting a name up for the job.

5. Tavenner once brought a patient back from the dead. Yes, seriously. Here's a bit from my profile last year, as recounted by an ICU surgeon Tavenner worked with in Virginia:

It was the middle of the night at Chippenham Hospital in Richmond, Va., where Tavenner worked as an intensive care unit nurse in the 1980s. [Eric] Swensson, the on-call surgeon, got notice around 2 a.m.: A woman had arrived, after suffering massive blood loss, and was pronounced dead.

“That’s about as tough of a case as you get, a girl who was thought to be dead,” Swensson recalls. “Marilyn was very supportive in everything, asking what we were doing, whether I was going to take her back to surgery. We came up with a game plan, and it was right on target. We used about 60 units of blood, but [the patient] ultimately walked out of the hospital.”

What Tavenner lacks in confirmation hearings, she certainly makes up in general fierceness!

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Neil Irwin · February 8, 2013